This interview with Jonathan Pearce occurred at the Interdisciplinary Summit on Orthopedic Value-Based Care in Newport Beach CA on January 21 2017. At that conference Jon presented on "Using Data to Develop CJR Strategies - 5 Things to Know" and "How Analytics Can Support Physicians"
BPCI participants who started in April 2015 are now eagerly awaiting their first reconciliation, which is scheduled to be released by January 1. Here's an overview of what you'll get with that first reconciliation.
By Jonathan W. Pearce, CPA, MBA, FHFMA and Jessica Walradt, MS
After several months of negotiations you've reached agreement with a contract physician group to provide hospitalist services in your hospital. This group has particular expertise in helping patients with multiple comorbidities and focuses on making sure that those patients get into the proper post-acute setting, which you hope will improve your performance in the Medicare Bundled Payment for Care Improvement (BPCI) CHF and COPD episodes in which you’re participating.
CMS has made the option available to BPCI participants to have their targets for the Major Joint Replacement of the Lower Extremity episodes stratified by whether the patient had a hip fracture. This issue is of concern to some BPCI participants because episodes involving fractures are considerably more costly than non-fracture episodes. While non-fracture episodes may cost $20-22,000, fracture episodes are typically 45-50% higher at $35-40,000.
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.
Note: this article was updated based on a webinar from CMS on 11/6/14.