BPCI Advanced, or the next iteration of CMS’s Bundled Payment for Care Improvement initiative, is coming. Despite the recent shake-ups at HHS, skilled nursing facilities (SNFs) that enroll in the program are poised to capture the rewards that stem from greater efficiencies and better patient outcomes during an episode of care. The successes many SNF participants achieved in the current BPCI Model 3 program should persuade more SNFs to consider participating. Be forewarned, however, the enrollment period for the opportunity analysis phase of BPCI Advanced will likely be brief, so it’s time to seriously consider these three key reasons for getting started now:
If CMS is consistent with its design, there will be no risk or obligation of any kind in the opportunity analysis phase of the program
Participation in BPCI Advanced may follow the same process as the original BPCI initiative, which had two phases: Phase 1, the opportunity analysis phase, which was non-binding, so participants were under no future obligation to participate in the program, and Phase 2, the full risk bearing phase, when the bundles selected became “live.”
In Phase 1 of the current BPCI initiative, SNFs could simply submit a non-binding letter of intent expressing initial interest in participating in the program. Then, after approximately six months, CMS provided the SNF’s historical data and target pricing to allow the facility to decide whether participating made operational and financial sense. In the original process there was no risk or downside, so it was essentially a free pass to see how the facility could benefit from participating in the BPCI initiative. After receiving their historical data and target prices, facilities had a short window to decide whether it made sense for the SNF to participate in Phase 2.
If facilities elected to participate in Phase 2, they became “episode initiators.” That meant the facility agreed to manage the continuum of post-acute care (PAC) delivery and take clinical and financial responsibility in order to share in any cost savings achieved below a target price for an episode of care. If facilities performed poorly, they were required to reimburse CMS for any costs above that target price. But facilities that analyzed the data from Phase 1 carefully and chose bundles appropriately were well positioned for success.
If BPCI Advanced follows the original process, SNFs who follow suit of their successful predecessors can expect limited risk and substantial benefits in both patient care and cost.
SNFs can receive valuable data, at no cost and with no strings attached
Even if SNFs decide not to go on and participate in the full risk bearing phase, they may still benefit from the historical data they receive from CMS in the opportunity analysis phase. That data can show them how well they’re managing patients across entire episodes of care and help identify provider partners who aren’t delivering positive outcomes. And, if the data shows success at managing the continuum of PAC efficiently, they would also be able to show those results to potential referral sources.
Getting the historical data and target pricing from CMS is easy; making sense of the data is not. SNFs need to partner with a company that specializes in analyzing and evaluating raw CMS data, and who can advise them whether the BPCI Advanced program offers significant upside potential for SNFs.
SNFs can earn a bonus for being a high-quality provider and accelerating value-based care initiatives
In a traditional fee-for-service environment, providers are paid for volume and not quality and value. Value-based care (VBC) is here to stay, and CMS is committed to rewarding facilities that accelerate the ongoing transition away from fee-for-service. Among the many VBC initiatives, the BPCI Model 3 program is unique in that it allows PAC providers to take significant clinical and financial responsibility for the patient. Almost all other VBC programs are oriented toward hospitals and physicians who take the risk and reap the rewards of the performance of all providers caring for the patient. While participation in BPCI Advanced involves accepting some risk in exchange for potential reward, a partner or “Awardee Convener” with existing program experience can help analyze your data, share best practices, advise whether a facility is likely to benefit from participating in the BPCI Advanced program, and support them through the entire three-year program.
Our organization partners with more than half the SNFs participating in the current BPCI Model 3 program, assisting them with all aspects of participation, including risk sharing when episodes went live in Phase 2, and care coordination to improve outcomes and patient satisfaction. These partners have consistently reduced readmission rates on average for 90-day episodes by almost 17 percent and achieved 13 percent savings below CMS’s target prices. Their experiences over the last two years are ample proof that SNFs working with a specialized Awardee Convener can generate excellent results consistently under VBC models.
What’s the bottom line? The window of opportunity to participate in CMS’s BPCI Advanced program will open soon but will close quickly, and opting into the opportunity analysis phase is a prudent first step. What SNFs can learn during that phase could put them on the path toward better financial performance and improved patient outcomes—both important aims for value-based care.
Gene Huang leads the SNF Model 3 bundled payment business for Remedy Partners and has been with the company since July 2012.
