JUNE 26, 2019

Welcome to the Bundled Payment Update eNewsletter
Editor: Philip L. Ronning
This issue sponsored by the National HIPAA Summit and the Population Health Colloquium.

CMS Identifies Keys to Success in Bundled Payment as BPCI-A Deadline Looms


  • Providers wishing to join the voluntary BPCI-A program have until June 24 to apply for the program's final open-enrollment period.
  • Some hospitals that have earned bonus payments under the mandatory CJR bundles have not collected the payments.
  • The administration is considering extending the CJR program, which has only one year left.

Click on link to find full text.

(Hospital Financial Management Association, June 19, 2019)

Association of Medicare's Bundled Payments for Care Improvement Initiative With Patient-Reported Outcomes


Objective To determine whether the Bundled Payments for Care Improvement (BPCI) initiative affected patient-reported measures of quality.

Data Sources Surveys of Medicare fee-for-service beneficiaries discharged from acute care hospitals participating in BPCI Model 2 and comparison hospitals between October 2014 and June 2017. Variables from Medicare administrative data and the Provider of Services file were used for sampling and risk adjustment.

Study Design We estimated risk-adjusted differences in patient-reported measures of care experience and changes in functional status, for beneficiaries treated by BPCI and comparison hospitals.

Data Collection We selected a stratified random sample of BPCI and matched comparison beneficiaries. We fielded nine waves of surveys using a mail and phone protocol, yielding 29 193 BPCI and 29 913 comparison respondents.

Principal Findings Most BPCI and comparison survey respondents reported a positive care experience and high satisfaction. BPCI respondents were slightly less likely than comparison respondents to report positive care experience or high satisfaction. Despite these differences in care experience, there was no difference between BPCI and comparison respondents in self-reported functional status approximately 90 days after hospital discharge.

Conclusions These findings reduce concerns that BPCI may have unintentionally harmed patient health but suggest room for improvement in patient care experience.

(Health Services Research, April 2019)

COA Proposes New Oncology Care Model with Value-Based Purchasing The Community Oncology Alliance
(COA) recently submitted an alternative payment model proposal to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) that builds on the work done by Medicare's Oncology Care Model (OCM). Dubbed the OCM 2.0, the alternative payment model retains the bundled payment format of the OCM but more aggressively addresses the culprit behind rapidly rising cancer care costs: prescription drugs. The proposed model would foster value-based purchasing contracts between payers, providers, and drug manufacturers to lower the costs of prescription drugs for cancer. "This proposal reflects a commitment to helping build the cancer care system of the future that patients, providers, and payers all want," Michael Diaz, MD, president of COA and a practicing medical oncologist at Florida Cancer Specialists & Research Institute, stated in the model's announcement. "We urgently request that the committee take the recommendations of community oncology practices who are on the frontlines of treating this devastating disease and help us transform cancer care for generations to come." (RevCycle Intelligence, June 14, 2019)

The Changing Bundled Payment Landscape for ASCs -- What to Know About Risk, Payers & Future Trends
Adopting a new payment system comes with risks, and having an idea about how much risk to take on as well as understanding expectations for payment for different services are just some of the details for ASCs to consider when developing bundles, according to Daniel Murrey, MD, chief medical officer for Surgical Care Affiliates. "There are several aspects that help determine which specialties are most effective in the bundled payment space. One is having few compounded variables that will change the risk profile," Dr. Murrey said. "Procedures like total joint replacements or spinal fusion procedures that have a homogeneous patient population make it easier to create a single price point and expectation for what the cost expenditure is going to be." One of the other risks involved with creating bundled payments for orthopedics is variable costs for physician preference items. "For instance, if you are doing a joint replacement, the cost of the implant is often the most variable piece of that, so [ASCs] should address if they have a program in place that gives them the confidence that they can manage that expense," Dr. Murrey said. "There's a lot of expenses that you would incur to create and develop a bundle, including lawyers making sure the regulatory environment within your market or state doesn't preclude these types of arrangements," he said. Expenses can also manifest in the form of not having sufficient claims data that ASCs can use to set target prices. (Becker's ASC Review, June 3, 2019)

Reduced Spending with Mandatory Bundled Payments for Joint Replacements

Launched in 2016, the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model provides a wide-scale, mandatory, episode-based bundled payment program for lower extremity joint replacement. This alternative payment model incentivizes hospitals, physicians, and postacute care from initial hospitalization through 90 days of recovery to reduce episodic costs without negatively affecting outcomes. Market-level randomization of the CJR program to an array of metropolitan statistical areas forms a natural test-bed for health policy experiments, including the well-designed, intention-to-treat, difference-in-differences study in this issue of JAMA Internal Medicine. The study provides a timely analysis of how the CJR program is progressing toward its goal of slowing Medicare spending without sacrificing quality. We comment on the assessment of differences in spending, use, quality, and patient characteristics between hospitals participating in CJR with non-CJR institutions during the first 18 months of the program.

(JAMA Internal Medicine, June 3, 2019)

5 Findings from the June 2019 Issue of AJMC®
The June issue of The American Journal of Managed Care® (AJMC®) featured research on care coordination and low back pain therapy in addition to studies on its theme of oncology. Here are 5 findings from research published in the issue.

  1. Care pathways continue to influence patient care and begin to integrate with other value-based initiatives.
  2. Care coordination programs reduce readmissions, improve HIV suppression rates
  3. Patients in restrictive plans less likely to choose conservative therapy for low back pain
  4. Medicare cancer care spending varies by site of chemotherapy
  5. Following decision support recommendations for hospital discharge linked to improved outcomes

(American Journal of Managed Care, June 2019)

Providers Are Ready to Shoulder More Downside Risk, Survey Shows
This study by Navigant and HFMA asked 170 hospital and health system finance executives their thoughts and ambitions around risk assumption and found that 72 percent of executives both believe their organizations have the capabilities to support increased risk and plan to take on additional risk in the next one to three years. Click on the above link to see the MedCity News summary of this study.

Click on image to launch an infographic from the study.

(Navigant/hfma, June 2019)

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How the CMS Blue Button, FHIR APIs for EHR Data and Other CMS IT Initiatives Can Support Care Redesign

Aneesh Chopra, MPP
President, CareJourney; Co-Founder/Executive Vice President, Hunch Analytics; Former Assistant to the President and Chief Technology Officer, Executive Office of the President (Obama), Washington, DC