Industry Insights

"Shock and awe" were words that many of our clients used when they received their ”mock” reconciliation data from CMS in early May. Some were dismayed at the significant reduction in financial surpluses from those that were expected, while others were alarmed by several apparent policy changes that have been implemented without notice and after contracts were signed. This article will discuss what we expected to see, what we actually saw, what we see as the consequent effects on reconciliation, and where we believe policy changes must be forthcoming.

A professional colleague recently commented that some of his clients were considering bypassing the Medicare Bundled Payments for Care Improvement (BPCI) program and were focusing on pursuing bundled payments with commercial payers. As we’ve previously written, we think that BPCI is one of the best advanced payment system options available, and it worthy of consideration by almost every hospital.

The Medicare Bundled Payment for Care Improvement (BPCI) program offers hospitals and post-acute providers the opportunity to work collaboratively to coordinate care occurring during and after an inpatient stay, and to retain most of the savings that may be generated as a result of the elimination of unnecessary provider services. The Centers for Medicare and Medicaid Services (CMS) is allowing providers that are already participating in this program to evaluate expanding their participation to additional episode families.