There are many more hospitals and physician groups signing up for BPCI Advanced than for the first go-round of the bundled payment program, BPCI, according to two experts interviewed.
Today, August 8, was the deadline for health systems to decide whether to join the voluntary Bundled Payment for Care Initiative Advanced program, for an October 1 start date.
The Centers for Medicare and Medicaid Services said in June it had seen robust interest in BPCI Advanced and that has turned out to be true, according to consultant and bundled payment expert Deirdre Baggot, who rolled out one of the first cardiovascular bundles at Exempla St. Joseph Hospital and has helped more than 200-plus healthcare organizations launch bundled payment programs.
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On Wednesday morning, Baggot was still helping providers submit their information. The deadline is midnight.
"There is really strong interest, surprisingly more interest," Baggot said. "I think organizations are more comfortable than five years ago in taking risk. Providers understand that MACRA is not going away."
BPCI: Here's how it works
Starting October 1, providers can participate in the risk program without taking on risk, she said. CMS is offering a test run of sorts through March 2019. Or providers can sign on for BPCI Advanced for a January 2020 start date.
"The benefit now is organizations get six months of a trial period," Baggot said.
The time is right as providers are more ready to move to value-based care and take on risk, Baggot said. MACRA is providing the initiative because, unlike the former BPCI, the program qualifies as an alternative payment model under MACRA and its 5 percent bonus.
Starting in March, organizations can look at performance and drop the bundled programs that are underperforming.
"It used to be a hard sell," Baggot said. "This time they are in a better position to compete on value. The work necessary goes way beyond Medicare. It requires the whole organization and culture to think differently. The level of participation is better than I've ever seen it."
The carrot of a MACRA bonus is contributing to that level, she said.
"I think the MACRA bonus payment is one of the biggest drivers," she said.
And not just for hospital and physician groups. Commercial payers are coming to the table ready to invest in infrastructure for value-based payments, she said.
The 90-day bundle program includes 29 inpatient and 3 outpatient bundles, compared to 48, and no outpatient, in the first round.
But Baggot sees room for improvement.
"One nut that we haven't really cracked is how we effectively engage patients," she said. "If we're really honest with ourselves, we didn't learn a lot on how to engage patients."
Technology such as wearables help, she said. And the design of the BPCI program allows hospitals to incentivize patients by giving them an IPad and take it home for telehealth.
Earlier this year, organizations such as the American Hospital Association had asked for a delay in implementing BPCI Advanced citing a lack of operational detail, especially over target pricing. The application deadline remained March 12, with target pricing coming out after that. The recommendation was to apply, before a final decision had to be made on August 8.
Chris Garcia, CEO of convener participant Remedy Partners, said at the time that target pricing would help determine the number of providers taking part in BPCI Advanced.
Target pricing turned out to be a mixed bag, Garcia said Wednesday. There were certain bundles that received more difficult pricing than others. Some specialties, such as orthopedics, were hit harder than others.
BPCI Advanced vs BPCI classic: What's different
Under BPCI Advanced, unlike BPCI classic, as Garcia calls it, the target pricing is based on the average baseline spending from 2013 to 2016. Under BPCI classic, it was 2009-2012.
CMS looks at the average spending in the baseline period to determine a target price.
If the average spending for a bundle was lower in advanced than basic, the target price will be lower, meaning to succeed, systems will have to come in lower than that, Garcia said.
It's led to the question, he said, "Isn't this program cannibalizing itself?" Because as providers get better, the program becomes more stringent. But Garcia said he stills sees many opportunities for hospitals and physicians to succeed in the program.
"It's a much bigger program this year than last year," Garcia said.
"With BPCI classic, we found ourselves just having to educate on what bundled payments are. This time we found people very educated. When we went to the market in January, we found a receptive audience."
This year, 800 hospitals and physicians groups have signed on with Remedy, compared to 200 in BPCI classic.
"That's a testament not only to classic program, but (the knowledge) you can actually improve outcomes while reducing cost," Garcia said. "This isn't going away. This is likely the way payers reimburse."