Bundled Payments for Care Improvement (BPCI) Initiative Healthcare - - PDF document

▶
bundled payments for care improvement bpci initiative
SMART_READER_LITE
LIVE PREVIEW

Bundled Payments for Care Improvement (BPCI) Initiative Healthcare - - PDF document

Jun 22, 2023 225 likes •332 views

5/24/2017 Bundled Payments for Care Improvement (BPCI) Initiative Healthcare Financial Management Association Cathy Ball, Director, Bundled Payments Initiative Lahey Clinical Performance Network (LCPN) June 2, 2017 DISCLAIMER: The statements

slide-1
SLIDE 1

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 1

Bundled Payments for Care Improvement (BPCI) Initiative Healthcare Financial Management Association

Cathy Ball, Director, Bundled Payments Initiative Lahey Clinical Performance Network (LCPN) June 2, 2017

DISCLAIMER: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Agenda

  • 1. Introductions
  • 2. Overview of Lahey BPCI Initiative
  • 3. Implementing a Bundle
  • 4. Lessons Learned/ Challenges/ Rewards
  • 5. Questions

a) Appendix: Commonly Used Acronyms

3

Bundled Payments for Care Improvement (BPCI)

slide-2
SLIDE 2

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 2

4

BPCI – Value-Based Payment Model

  • “Population Health”
  • ACA Legislation 2010 – Centers for Medicare and Medicaid Innovation (CMMI)
  • Pay for Value, not Volume with quality gaits

5

CMMI - Value Based Models

  • BPCI 1 – Five-year voluntary pilot initiative – 10/13/13 – 9/30/18
  • Comprehensive Joint Replacement (CJR) – Mandatory – 4/1/16 –

12/31/2020

  • 67 Metropolitan Service Areas (MSA)
  • Oncology Care Model (OCM) – 7/1/16 – 6/30/21
  • Six month chemotherapy
  • Cardiac Bundle (AMI, PCI, & CABG) – Mandatory – Begins 10/1/17
  • Medical treatment, procedures, and emphasis on cardiac rehab
  • Surgical Hip and Femur Fracture Treatment (SHFFT)
  • 98 Metropolitan Service Areas (MSA)
  • New Bundled Payments Model (TBD)
slide-3
SLIDE 3

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 3

6

BPCI – Bundled Payments for Care Improvement

CMS Aim: Better Health, Better Care, Lower Costs

  • 1. Four different options offered by CMMI (Center for Medicare & Medicaid

Innovation):

– Model 1 – Retrospective Acute Care Hospital Only – Model 2 – Retrospective Acute Care Hospital Stay plus Post-Acute Care – Model 3 – Retrospective Post-Acute Care Only – Model 4 – Prospective Acute Care Hospital Stay Only

  • 2. Model 2 post-acute timeframe can be 30, 60 or 90 days
  • 3. Two years into the pilot, Models 1 & 4 are phasing out, Model 2 most

popular and implementation model selected for mandatory bundles

  • 4. Payments continue via PPS methodology during pilot episodic based

payments (EPM)

7

Acute hospitalization at Lahey - Burlington Acute hospitalization at Lahey - Burlington

Bundled Payments for Care Improvement (BPCI)

  • Current => Hospital and Physician services have adapted to a “DRG

Mentality” where we manage cost for acute hospital stay:

Acute Discharge (~4.6 days)

(All inpatient cost, including OR time, supplies, and implants, post operative care, Inpatient and post op consults, rehab, CM)

  • Future => New model (Bundled Pymt, Model 2) – manage total

continuum of care episode costs:

90 days post-d/c (~94.6 days)

(Inpt Rehab, SNF, HHA, LTCH, PCP/Specialist, OP Appts, DME)

  • Current => Individual payments Future => One Bundled

payment by care setting tied to quality

slide-4
SLIDE 4

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 4

  • 48 pilot bundles – organized by service line

8

Bundled Payments for Care Improvement (BPCI)

Cardio Ortho Neuro Diabetes/ Vascular Gastroenterology / Colon/ Rectal Pulmonary Infection Control Other

  • Acute Myocardial

Infarction (AMI)

  • Atherosclerosis
  • Auto-implantable

Cardiac Defibrillator

  • CABG/ CABG
  • Cardiac Arrhythmia
  • Cardiac Defibrillator
  • Cardiac Valve
  • Chest Pain
  • Congestive Heart

Failure (CHF)*

  • Pacemaker Device

Rep/ Revision

  • Pacemaker
  • PCI
  • Syncope &

Collapse

  • Double Joint

Replacement – LE

  • Fractures – Femur and

Hip/ Pelvis

  • Hip & Femur Proc

(except major jt.)

  • Lower Extremity &

Humerus Procedure (ex. hip, foot & femur)

  • Major Joint Lower

Extremity TJA CJR

  • Major Joint Upper

Extremity

  • Medical Non-infectious

Orthopaedic

  • Other Knee Procedures
  • Removal of

Orthopaedic Devices

  • Revision of Hip or Knee
  • Back & Neck

(except spinal fusion)

  • Cervical Spinal

Fusion

  • Combined Ant/

Post Spinal Fusion

  • Complex non-

Cervical Spinal Fusion

  • Spinal Fusion

(non-Cervical)

  • Stroke
  • Transient Ischemia
  • Amputation
  • Diabetes*
  • Medical

Peripheral Vascular Disorders

  • Nutritional &

Metabolic Disorders

  • Other Vascular

Surgery

  • Renal Failure
  • Esophagitis,

Gastroenteritis, &

  • ther Dig Disorders
  • Gastrointestinal

Hemorrhage

  • Gastrointestinal

Obstruction

  • Major Bowel
  • Chronic

Obstructive Pulmonary Disease (COPD)*

  • Other Respiratory
  • Simple Pneumonia

& Respiratory Infections

  • Cellulitis
  • Sepsis
  • Urinary

Tract Infection

  • Red Blood

Cell Disorders

Red = CMS, voluntary pilot, at risk (LHMC only) Purple= CMS, mandatory, system-wide 7/1/17 Teal = Commercial bundle pilots (LHMC only)

*Commonly followed by ACO

9

BPCI – Project Milestones

slide-5
SLIDE 5

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 5

  • Steering Committee – Project Champion, Project Manager, Home Dept.
  • Project Charter
  • Problem Statement
  • Metrics
  • Aim, Goals - Risks, Barriers/Constraints
  • Resources
  • Milestones/ Timeline
  • Organizational Readiness Assessment
  • Bundle Selection
  • strategic alignment
  • ~100 episodes annually
  • current performance

10

BPCI – Implementing A Bundle

11

BPCI – LHS Bundle Pilot Infrastructure

  • Program Director
  • Project Manager (1 FTE for 2 bundles); Case Managers based on bundle volume
  • BPCI Convener
  • Public Policy/Issues Forum/ CMS Liaison
  • Project Manager Roundtables
  • Data Analytics/ Reports/ Interpretation
  • Advisory Meetings/ Services
  • Training Resources
  • Administrative Workgroup – clinical, finance, legal, HIM, supply chain, care coordination,

quality, IT

  • Multidisciplinary, multi-setting team per bundle
  • Community Resource Network – services not provided by hospital/ health system but

integral to patient’s episode of care (anchor stay + 90 days)

  • Pre-admission for elective bundles: Preventative services, health optimization, patient

education

  • Post-acute discharge: Acute Inpt Rehab, SNFs, Home Health, OP Svcs, Transportation,

Hospice, Assisted Living Communities, Long-term Acute Care organizations, Meals on Wheels, Elder/ Senior Centers, Social Work resources, etc.

slide-6
SLIDE 6

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 6

Team Membership

  • Physician Champion
  • Nurse Champion
  • Service Line Director (SLD)
  • Case Management
  • Rehabilitation Services (PT, OT, & ST)
  • Pharmacy
  • Hospitalist
  • Nutrition
  • Amb Clinic and Inpt PAs, NPs
  • Patient Representative
  • Post-acute Representatives

12

BPCI – Multidisciplinary Bundle Teams

Subject Matter Experts (as needed)

  • Lab, Radiology
  • HIM, CDI
  • Surgical Services, PACU
  • OR Scheduling
  • Hospitalist
  • Nutrition
  • IT
  • Legal
  • Quality
  • Risk Management
  • Finance, Supply Chain

13

BPCI – Business Process Re-engineering

slide-7
SLIDE 7

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 7

14

BPCI – Resulting Improvements

  • Pre-op patient education class (TJA); Inpt education class (CABG)
  • SNF 3-day waiver
  • Patient Compact
  • Standard Treatment Protocols across settings (anti-coag, blood mgmt, etc.)
  • Wound dressing pilot – 7-day dressing Pilot 3/2014; hospital-wide 12/2014
  • Prescriptions filled as leaving hospital for home – Pilot 6/9/14; Sun 6/2016
  • Insurance Authorization delays in discharge/ prescription filling
  • One number to call with questions 24/7
  • Accelerated Ambulation – starts in PACU
  • Working DRG (CDI Team) and Estimated discharge date (new)
  • Readmits due to dehydration - Major Bowel, Transplant (new)
  • Lahey Care Link for post-acute organization access to test results (new)

15

BPCI – Data Analytics is Crucial

Before Pilot Adoption

  • Internal acute cost and quality data metrics only
  • No post-acute provider utilization data beyond first d/c disposition location
  • No acute or post-acute benchmarks for comparison
  • No trending of current costs, LOS, or outcomes across care continuum

After Pilot Adoption

  • Provided with mock reconciliation estimates to trend performance
  • Verify all bundle patients & identify outliers, readmissions, ED visits, etc.
  • Identification of high-level practice variations across providers
  • ID post-acute services utilized, LOS, & costs across 90-day episode
  • High-level pricing benchmarks nationally and within the state
slide-8
SLIDE 8

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 8

16

Challenges

  • No roadmap
  • Changing long-held paradigms of healthcare culture
  • Risk tolerance & retrospective results
  • Patient choice in selecting post-acute organizations
  • Unable to easily share information across care settings
  • Transition from historical to regional pricing

Rewards

  • Holistic (episodic) healthcare, ongoing process improvement
  • Colleague engagement - Multidisciplinary, multi-care setting teams
  • Leading-edge work, Shaping future of healthcare
  • Emphasis on patient outcomes

Bundled Payments for Care Improvement (BPCI)

17

BPCI – Lessons Learned

  • Leverage the technology in place – even if it means tracking patients

initially using Excel spreadsheets

  • MD Performance Data for eliminating practice variation
  • Working relationships and ongoing communication across

disciplines and care settings

  • Ongoing performance improvement – spread throughout
  • rganization
  • Data provided by CMS incredibly rich – important to have good data

analytics tools in place - Post-acute referral patterns, cost and LOS variances

  • Learning collaborative across system service lines
slide-9
SLIDE 9

5/24/2017 BPCI Overview: updated 7/26/2016 KC & LJ 9

Bundled Payments for Care Improvement (BPCI)

Thank you Questions?

18

http://innovation.cms.gov/initiatives/bundled-payments/#

19

BPCI – Commonly Used Acronyms

ACR Description ACR Description ACR Description ACR Description

AAMC

  • Assoc. of American

Medical Colleges CMMI CMS Centers for Medicare & Medicaid Innovation IRF Inpatient Rehabilitation Facility QP Qualifying Participant ACO Accountable Care Organizations CMS Centers for Medicare & Medicaid Svcs MACRA Medicare Access and CHIP Reauthorization Act RRC Rural Referral Centers ALOS Average Length of Stay EDAC Excess Days in Acute Care MDH Medicare Dependent Hospital RSRR Risk-Standardized Readmission Rate AMI Acute Myocardial Infarction EMR Electronic Medical Record MIPS Merit-based Incentive Payment System SCH Sole Community Hospitals APM Alternative Payment Models EPM Episode Payment Model MS- DRG Medicare Severity Diagnosis Related Groups SDS Socio-Demographic Status BAA Business Associate Agreement HAI Hospital Acquired Injury MSSP Medicare Shared Savings Program SHFFT Surgical Hip/Femur Fracture Treatment BPCI Bundled Payment Care Improvement HIQR Hospital Inpatient Quality Reporting NHSN National Healthcare Surveillance Network SNF Skilled Nursing Facility CABG Coronary Artery Bypass Graft HRRP Hospital Readmissions Reduction Program NQF National Quality Forum VBP Value Based Purchasing program CAH Critical Access Hospital ICR Intensive Cardiac Rehabilitation OCM Oncology Care Model CEHRT Certified Electronic Health Record Technology IPPS Inpatient Prospective Payment System OPPS Outpatient Prospective Payment System CHIP Children's Health Insurance Program IQI Inpatient Quality Indicator PAC Post-acute care; also Potentially Avoidable Costs CJR Comprehensive Care for Joint Replacement IQR Inpatient Quality Reporting PY Performance Year