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.
Most applicants in the Medicare BPCI Advanced program are evaluating participation in various episodes with the goal of achieving financial success by reducing costs in those episodes. Some innovative hospitals, however, are applying an additional criterion for participation in some episodes.
Along with the BPCI Advanced claims data, CMS provided to applicants with an Excel workbook named 2018_05_31_bpid-0000_Baseline_MY_1_2_Prelim_TP.xlsx containing the preliminary targets for all episode types in which the hospital had sufficient baseline episode volume. Those workbooks also contained the three factors that are used to adjust each hospital's baseline cost to compute the final target amount.
Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH
(Note - this article was written in 2015 referring to the BPCP program but remains relevant in BPCI Advanced.)
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.