Single Tracks Blog Archive

Which Episodes Should I Bundle for BPCI

by Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH

Applicants to the Medicare Bundled Payment for Care Improvement (BPCI) program will be busy spending December identifying episodes for which they should participate when they "go live" in April. Several episode families are common candidates for participation, and an overview of their characteristics is described below.

CMS Announces Significant Changes in the BPCI Reconciliation Process

Note: this article was updated based on a webinar from CMS on 11/6/14.

BPCI Episode Selection – An Analytic Approach

Achieving success in the Medicare Bundled Medicare Bundled Payment for Care Improvement initiative requires analyzing historical data to identify the opportunities and risks associated in each of the episode families, as well as the other decision points in BPCI participation. Careful evaluation of opportunities and risks before making participation decisions can pay off significantly when the at-risk period begins.

Evaluating Your First BPCI Reconciliation

Most BPCI participants will undergo their first BPCI reconciliation in October, which will cover the first quarter of 2014. We’ve heard that some participants appear to be basing their ongoing participation in the BPCI program on these results. If a surplus occurs, they’ll stay in the program and may even add additional episode families. But if the results are negative, they’ll be jumping ship faster than the captain of the Costa Concordia.

Estimating Financial Risk in Medicare Bundled Payment

In our previous article on this topic we discussed ways in which randomness in patient selection causes variations in average episode costs. Even for higher-volume DRGs, these variations can create significant differences in the settlement amounts during CMS reconciliations. In this article we describe a simulation methodology that allows estimating the extent to which these variations will occur.

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