Whether voluntary or mandatory, bundled payment programs from the Centers for Medicare & Medicaid Services (CMS) continue the shift to value-based care in the United States. The momentum behind bundled payments is not limited to Medicare reimbursement dollars, as Payers are also moving toward the adoption of bundled payments and other alternative payment models.
The time is now
In early 2018, providers must make a decision: whether to participate in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) voluntary bundled payment model. This program qualifies as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program (QPP).
Those who do not apply are not eligible to apply for 15 months. Those who do apply by March 12, 2018 will have until October 1, 2018 to choose from among the 33 bundles and implement them – or they can choose not to participate after all. Our consultants can help with both the decision and application processes.
The Comprehensive Care for Joint Replacement (CJR) bundled payment model is now in its third year, and penalties for providers began July 1, 2017. In November, 2017, CMS reduced the number of mandatory geographic areas for CJR participation from 67 to 34 areas. Conversations with many of our clients reveal that they plan to continue with their CJR bundles, even though participation is now voluntary, because they are seeing value from them.
Other updates include:
Providers who develop an accurate and objective assessment of their current risks, gaps and opportunities now will be positioned to succeed under value-based reimbursement programs, including Alternative Payment Models (APM). In spite of this, many acute inpatient care providers in the US report they are not adequately prepared with a clear path to success under bundled payment initiatives.
We can help
With robust data and analytics capabilities, a history of helping clients succeed under episode-based payment models since 2011, and partnerships to bring the best analytics to bear, Truven Health can help guide you through the decision to participate in, and the transition to, BPCI Advanced and other bundled payment programs.
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