Selecting episodes in BPCI Advanced requires an analytical process in which the opportunities for success are identified and quantified, and pathways for achieving that success can be developed.
When we heard that CMS has selected a new data contractor for the BPCI Advanced program, we remain optimistic about the quality of the data that we would receive for this program. Data for the BPCI and CJR programs was relatively complete, containing demographic information about patients (name, medical record number, zip code, etc.), payment components (DRG outlier payments, IMD, DSH, etc.), and other fields describing utilization levels.
In the BPCI program many hospitals and physicians selected individual episode families in which to participate. Providers participated in major joint replacement, congestive heart failure, simple pneumonia, and other similar types of episodes that have sufficient volume to create statistical stability and sufficient return on the care management investment.
CMS has finally released the long-awaited specifications for target price computation for the BPCI Advanced program. This document provides general guidance into the process used to determine these targets, but many details will not be clear until the actual targets are released.