There is justifiably a lot of excitement regarding the launch of Bundled Payments for Care Improvement Advanced (BPCI Advanced).
The original Bundled Payments for Care Improvement has been a tremendous success for many orthopedic group practices and hospital orthopedic service lines, providing new flexibility and aligning incentives to make significant improvements in the quality, outcomes and cost of care. As a result, many of these organizations and individual physicians have received significant rewards for their efforts.
As the Centers for Medicare & Medicaid Services (CMS) continues its drive towards value based care, the opportunity to participate in the new version of the program with the launch of BPCI Advanced is now open, which solidifies the role of the physician and their partners in leading the charge.
BPCI Advanced gives physicians precedence over hospitals in who “owns” (and holds the risk on) the bundle. Hospitals are third in line of precedence with the physician group associated with the listed attending physician having the first priority and the physician group associated with the operating surgeon having second priority. In many, if not most, elective orthopedic procedures, both the attending and operating physician are the same individual. The hospital can “own” the bundle only when neither the attending nor the operating physicians are in participating groups. While there are some orthopedic cases where a hospitalist is listed as the attending physician and the hospitalist’s group owns the bundle, we expect this to be the exception rather than the rule.
Either way, physicians are in the driver’s seat. Many of these groups are driven with their partners to take the program to new heights. Those partners often include conveners who have program management experience and data analytic, care coordination and care redesign expertise, and who often offer robust risk sharing and protection. These resources enable physician groups to confidentially enter programs that align their ability to improve the quality, outcomes and cost of an orthopedic episode with commensurate reward.
March 12th is the deadline to either apply to directly take the risk from CMS or to join a Convener Participant’s application. This non-binding step preserves your ability to evaluate the opportunity. Another opportunity to participate in the program will not come until 2020. Conveners can help evaluate the potential opportunity for physician group practices and, if the opportunity is attractive to the group, conveners can help them lead and succeed in BPCI Advanced, as Medicare intended them to do.
In our view, it makes sense to apply now through the Performance Solutions convener and preserve your option to participate in BPCI Advanced. There is no cost and no obligation to apply. We will obtain the CMS claims data for your episodes in May and analyze that data to show you your opportunity. Binding decisions on whether to participate do not have to be made until July. But why not take the easy step to apply through the Performance Solutions convener by talking with us today? For more information on how to apply, please contact us at spsinfo@stryker.com.
Geoff Walton, MHA
Geoff brings decades of experience in leading operations and strategic business development activities for hospitals and health systems to his role at Performance Solutions. As co-founder of Comprehensive Care Solutions—acquired by Stryker in 2012—Geoff and his team continue their work with physician organizations and health systems to align and turn reform into opportunity.
As an expert in new payment and delivery models, including Accountable Care Organizations and bundled payments, he works with the Performance Solutions team including clinical, legal, actuarial, group practice and hospital management to serve a wide range of client needs. Geoff is a co-founder of Secured Independence (now Alere), a geriatric population health company. He has a Bachelor of Arts degree in Economics from the State University of New York at Albany and a Master of Health Administration degree from the University of North Carolina at Chapel Hill.
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