Why participate in BPCI-A? A Primer for Physicians

Bundled Payments for Care Improvement Advanced (BPCI-A) is a Medicare value-based care program that rewards cost reduction and quality improvement with financial earnings. Participants — either hospitals or physician group practices — try to lower their spending below a “target” bundle price, set based on historical performance and patient population factors, while performing well on various quality measures. The bundle price includes most services provided to the patient during an initial hospitalization or procedure and for the 90 days thereafter.

So why participate?

• Financial incentives: earn savings if your spending is below the target price, up to 20% of the target prices across all your patients.
• Data availability: receive Medicare claims data for your BPCI-A patients, allowing insight into the whole trajectory of care. If you’ve ever wondered what happened to the patient after they left your practice, this will allow you to find out.
• Quality incentives: BPCI-A qualifies as an Advanced Alternative Payment Model (APM) under the QPP. Eligible practices can receive up to a 5% APM bonus and may be excluded from MIPS reporting requirements.
• Care redesign: leverage the program as a jumping-off point to drive practice transformation. Practices are required by the program to design and implement a care redesign plan.
• Peer-to-peer learning: connect with a network of other BPCI-A providers to share best practices.
• Get ahead of the game: value-based payment initiatives are becoming increasingly common and are expected to be mandatory in the future. Now is the best time to become familiar with these programs.

What are the risks of participation?

• Financial loss: the main risk most practices will worry about is financial loss if their spending is above the target price. The program caps losses at 20% of the sum of the target prices across all patients. Some practice have purchased additional financial risk protection on top of the program’s stop-loss.
• Administrative burden: the program requires substantial administrative work — from filling out and submitting forms to keeping track of deadlines. Most practices will want to partner with a convener or contractor to help manage these tasks.

Though BPCI-A and financial risk-taking can seem like a daunting task, SimplyVital Health has the expertise and infrastructure to provide the support you need through our modular sana program. Created by a former hospital administrator and data science team with direct experience succeeding in bundles, we provide multiple concierge services including actionable analytics, post-acute care strategy, care coordination, a collaborative coordination platform, and stop-loss insurance. For more information, contact us through our website at https://www.simplyvitalhealth.com/.

Join us for our next introductory webinar on BPCI-A on Tuesday, April 9 at 10 AM ET — register through this link: https://simplyvitalhealth.easywebinar.live/registration-5