Industry Insights

Participants in Medicare bundled payment programs want to know when an episode’s claims are “complete”, at which point the episode’s cost can be compared to the target price. Estimating the "claim lag" and completion rates, however, are hampered by the amount of variability in claims payment across episode types and individual episodes. This article will explore those issues and suggest a point at which such estimates can be made.

As described in this Singletrack Analytics blog article, the three target adjustment factors (efficiency, patient case mix adjustment (PCMA), and peer adjusted trend (PAT) can vary widely among hospitals in episode types.

CMS provided BPCI Advanced applicants with an unexpected gift in early July when they announced a "no harm, no foul" bailout opportunity for all participants occurring in March 2019. At that point, participants can retroactively terminate participation in any or all BPCI Advanced episodes, with no financial risk. This gives participants an additional eight months past the August 1 application deadline to evaluate opportunities in various selected episodes.