PCI Advanced is coming fast.
Given the success of many organizations in BPCI 1.0, surgeons and hospitals are eager to capitalize on the financial perks of quarterbacking the entire episode of care.
The basic idea of BPCI-A -- included as an Advanced Alternative Payment Model (AAPM) under MACRA -- is similar to BPCI 1.0 -- i.e. incentivize providers to reduce unnecessary variation across the holistic episode of care.
From our work with leading centers across the country, three themes have emerged as mission-critical to drive bundled payment success:
In the new bundle model- retrospective reconciliation will play a large roll in what your organization can get back from CMS. While we don't yet know specifics of this biannual calculation, we do know that quality performance can alter your reconciliation amount by up to 10%. So focusing on improving this metric is key, as it can have significant impact on your CMS reimbursement.
Patient optimization is a critical part of cost & quality improvement. There are a wide-range of validated risk assessment tools and research on the hard stops for surgery (e.g. A1C levels, BMI, smoking, etc.). It’s imperative that all physicians buy into and leverage these tools to ensure the right patients are being operated on. For patients who are not optimized, there must be resources to support them in the changes that can be made to get them to be a safe and successful surgical candidate.
For joint replacement, the variation in cost occurs after discharge (30-50% of total episode cost is post-acute). The hospital stay is micromanaged, but when patients return home, Care Teams lose complete control of the outcomes. Patients are on their own, and without ongoing education, communication or monitoring, problems arise.
Historically, Care Teams relied on traditional post-acute services (e.g. SNF, Home Health, Outpatient PT) to manage their patients’ recovery, but these services are costly and cannot be sustained. Many top centers have begun to digitize recovery with tele-rehab and remote navigation, proven to enable control for a lower cost, and this trend will only continue to grow.
You can’t improve what you can’t measure. In order to build a culture of ongoing improvement, you must track outcomes (e.g. PROs, patient satisfaction, etc.), episode costs and complications in as close to real-time as possible. Teams must have analytic capabilities to understand unnecessary physician and facility variation. Evidence will not only expose current opportunities, but can point to and validate future solutions.
The only way to achieve this efficiently is to increase connectivity with the patient, so data can be collected wherever they go. Implementing real-time monitoring that consistently engages patients is the best way to capture valuable data that can guide system-wide decision-making.
Even the most efficient providers are committing to care redesign in the face of BPCI-A. They will need to overhaul their service lines quickly and thoughtfully, in order to get the most bang for the healthcare buck with this new model. It’s time to embrace the change.
Applications are due March 12th. For information on how to apply, click here