BPCI Initiative Year 2 Lessons Learned
BPCI Initiative Year 2 Lessons Learned

Top Results from CMS’ Bundled Payments for Care Improvement Initiative Progress Report

The Centers for Medicare and Medicaid recently published CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 2 Evaluation & Monitoring Annual Report. If you have been following the recent developments of either the BPCI initiative or the Comprehensive Care for Joint Replacement mode (CJR), you are likely aware of their functions and similarities.

If not, here’s a quick overview. First, the BPCI initiative is a voluntary pilot program that is testing an alternative to the traditional fee-for-service reimbursement model that pays a hospital or clinic whenever it provides treatment—regardless of outcome.

Bundled payments, on the other hand, link all healthcare providers for an episode—such as hip or knee replacement surgeries that involve various treatments—and then evaluates outcomes of cost and performance.

CJR was introduced earlier this year to test a new reimbursement model for Medicare hip and knee replacement surgeries. Also known as lower extremity joint replacements (LEJRs), it is one of Medicare’s most common inpatient surgeries.

Both BPCI and CJR are designed to reward hospitals (or participant physician groups, in the case of BPCI) for improving care coordination and achieving cost savings aligned with a target price determined by CMS based on the participant’s historical performance. When the hospital reduces episode costs below the target price, they receive a share of the savings. If payments remain above the target price, the hospital may owe a reconciliation payment to CMS.

Since the CJR program and the BPCI initiative are similar in structure and design (with 83 percent of BPCI episodes included in the CMS report identified as orthopedic episodes) there are lessons to be learned in the report and applied to organizations affected by CJR and other burgeoning bundled payment initiatives. Some top takeaways:

Post-Acute Care Management is Key to BPCI Episode Spending

BPCI initiative participants that saw the most reduction in episode spending were those that achieved a marked decrease in SNF (skilled nursing facility) utilization, some up to almost five percent reduction compared to baseline.

BPCI Care Quality is Not Suffering

The BPCI initiative has its share of critics that are justifiably concerned about its potentially negative impacts on quality. However, the orthopedic BPCI data is thus far indicating that quality outcomes have remained high for participants, with no significant changes from baseline.

BPCI is Resulting in Episode Payment Savings

This early data shows that almost 90 percent of BPCI participants achieved a decline in episode payments. There has been an estimated $2000 per-episode average decline in payments correlated with appropriate utilization of post-acute care facilities and decrease in length of stay, among other factors.

Patient Management Proving to be Crucial BPCI Success Factor

Those that are targeting patient management resources are seeing the successes outlined above. This includes:

• Workflow redesign

• Care coordination

• Case management

• Patient navigation

Although there is still not a universally agreed upon set of best practices for patient management and BPCI success, the data is indicating that a combination of activities are pulling healthcare providers in the right direction, such as:

• Leadership buy-in

• Resource allocation

• Patient-centered care teams

With these lessons learned from the BPCI Year 2 Evaluation, do you have the tools you need to be successful in CJR? Contact Sequence Health to learn how you can optimize the patient care coordination process using the Sequence platform.