CMS为考虑参加BPCI Advanced的组织提供了第二次申请期. 许多组织已经提交了非约束性申请,以获得详细的索赔数据,这些数据将为组织在37例住院和门诊事件中的绩效提供有价值的见解, as well as post-acute performance. The claims data is scheduled to be provided by CMS in September. 参与决定将于11月做出,因此审查数据的时间有限.
考虑参加BPCI高级计划的组织在决定参加该计划之前,应从战略和财务角度对参与情况进行评估.
Strategic Fit
Before an organization receives the claims data from CMS, it should evaluate its strategic fit for participation in BPCI Advanced. Many organizations begin by looking at the broader program-level fit, 然后专注于bet8娱乐线的优势和/或可能感兴趣或显示财务机会的章节. 我们已经概述了一些关键组件,这些组件将有助于确定BPCI Advanced在多大程度上适合组织的战略.
Organizational Readiness
拥有基于价值的支付经验或希望更多了解这些项目的组织是参与的最佳人选. 这些组织可能已经有了基于价值的合同,或者正在制定这样的合同. 我们发现,这些组织通常将参与和学习基于价值的支付模式作为高度战略优先事项. 像BPCI Advanced这样的捆绑付款计划提供了一个机会,可以在短时间内(入院/程序加上90天)专注于目标人群。, while having a clear understanding of the financial risk and opportunity.
Physician Alignment
BPCI Advanced允许组织通过合同收益共享安排与参与的bet8网站备用分享捆绑付款中的任何节省. 这样的安排为bet8网站备用提供了质量和经济激励,鼓励他们满足组织要求, operational, and quality metrics by improving care and reducing costs (Medicare spend). If any service lines could benefit from increased physician alignment, 实施收益共享模式是加强bet8娱乐线和提升医师战略的好机会.
Post-Acute Collaboration
Post-acute care is a critical component of the BPCI Advanced program, as all episodes include financial risk for 90 days postadmission or procedure. 为患者选择最佳的急性后环境将确保适当和最具成本效益的护理水平,并降低成本. 参与高级BPCI要求组织了解其急性后网络并有效地管理整个网络中的护理. Often, 组织需要开发一个使用可测量数据(如质量评级)的首选网络, length of stay, readmission, etc. in order to evaluate performance. BPCI高级提供了一个机会,与急性后护理提供者建立更多的协作工作安排.
Information Management
To understand performance in BPCI Advanced, organizations will need to collect and analyze financial, operational, and quality data. 允许报告关键信息的信息管理功能将帮助领导者更有效地管理患者和提供者. 组织将需要采取多学科方法来组织来自多个职能领域的投入和参与, including quality, IT, and data analytics.
Financial Aspects of Episode Selection
Once an organization receives claims data from CMS, it can begin to review and analyze the information. 这一综述将有助于在知情的情况下决定选择哪一集. Considerations include:
- Volume of episodes.
- Readmissions and post-acute utilization.
- Episode cost compared to target price.
Volume of Episodes
Of the 37 clinical episodes, CMS will only consider those with sufficient volume, 哪一种定义是在四年的基准期内在医院至少有41次发作. Even if it meets the minimum threshold of 41 episodes, an organization could view a particular episode as being low volume, with greater financial risk and not enough financial opportunity.
Readmissions and Post-Acute Utilization
各组织还需要考虑急性期后的利用情况以及在他们的病例选择过程中的相应支出. 数据通常显示急症后护理费用占总支出的50%至80%. 人们可以将这些较高的急性期后护理费用视为一种风险,也可以将其视为管理这些患者并减少利用率的机会. In ECG’s experience, 具有明确和积极的急性后护理管理策略的组织在BPCI高级治疗方面取得了良好的成功.
与技术熟练的护理机构和住院康复中心合作至关重要,这些中心的重点是实现合理的住院时间和减少再入院率. BPCI高级参与者有机会制定急性后护理bet8娱乐的操作和质量指标,旨在减少不必要的利用和支出,同时提高质量.
Episode Cost Compared to Target Price
Finally, 组织将需要选择他们有信心能够实现比目标价格更低成本的剧集. The financial consideration is key, 因为它将决定一个组织的支出低于目标价格的可能性, generating a financial surplus under BPCI Advanced. 事件成本与目标价格的比较可以通过CMS索赔数据进行历史评估, which contains three years of data.
Balancing Strategy and Financial Factors
组织可能在某些领域准备充分,而在其他领域准备不足, as per the opportunities and risks outlined above. 对战略和财务因素的全面审查将有助于组织确定其对高级BPCI的准备. ECG将剧集选择过程视为一项财务和战略工作. Therefore, 那些花时间完成对关键战略和财务因素的全面审查的组织将处于成功参与BPCI Advanced的最佳位置.
Published July 31, 2019