Bundled Payments for Care Improvement - Advanced January 15, 2018 - - PowerPoint PPT Presentation
Bundled Payments for Care Improvement - Advanced January 15, 2018 Agenda for today 1 Welcome & Introductions 2 Strategies for the early phases of BPCI Advanced 3 Review of the opportunity Why should you be interested? 4 Overview of
January 15, 2018
2
1 Welcome & Introductions 2 Strategies for the early phases of BPCI Advanced 3 Review of the opportunity – Why should you be interested? 4 Overview of BPCI-A 5 A look at the CV data 6 Your first steps & actions 7 Q&A
3
4
Keely Macmillan GM BPCI Advanced Archway Health Ginger Biesbrock Vice President MedAxiom
Dave Terry
CEO & Co-Founder Archway Health Joel Sauer Vice President MedAxiom
5
The MedAxiom & Archway Health partnership is intended to make design and implementation of bundled payment programs as simple as possible for heart programs. The team combines the expertise of CV consultants, proven healthcare operators, big data analysts, and technology entrepreneurs.
EDUCATION DATA READINESS & OPTIMIZATION TOOLS & SOLUTIONS
6
Company Background
Experienced Team
– A Convener in the BPCI program Trusted Partner
markets Real Results
– Up to $12 million annually per hospital – Up $100,000 per physician in PGPs
7
24 pages, not a 30- minute process!
9
12 Components of BPCI Advanced Application, Due March 12th 30+ Narrative questions
Each component has several narrative questions:
1. Organization Information, including CEHRT attestation, participant list, and executive summary of application 2. Practitioner Engagement – including plan for consent, retention, and adherence for care redesign 3. Care Improvement – plan for care redesign care processes in evidence-based medicine, beneficiary/caregiver engagement, quality and care coordination, including readiness assessment 4. NPRA Sharing –experience in gainsharing and P4P initiatives, and proposed methodology for BPCI Advanced gainsharing 5. Quality Improvement – including experience in improvement interventions and plan for quality improvement in BPCI A
10
12 Components of BPCI Advanced Application, Due March 12th 30+ Narrative questions (Cont…)
Each component has several narrative questions:
6. Quality Assurance – Approach to ensure clinical appropriateness, including Sanctions, Investigations, Probations, or Corrective Action Plans 7. Beneficiary Protections –plan for beneficiary protection, education, engagement 8. Financial Arrangements- planned gainsharing arrangements and funds flow mechanism 9. Organizational Capabilities and Readiness –
13
14
Phase I: Pre-Program Activities Phase II: Program Design Phase III: Program Management Phase IV: Continuous Performance Improvement
Opportunity Assessment
Evaluation
Submission
Analysis
submission
leadership structure
Priority Opportunity Areas
Process Design
Provider Network Development
Gainsharing & Collaboration Agreements
Performance Tracking – Archway Analytics
Tracking – Archway Carelink
Reconciliation Management
Reporting
Sharing
Coaching & Training
Innovations
Employer Contracts
Recruiting
Drops
16
17
Anchor IP HHA IRF LTCH HOPD Readmissions SNF
State avg post acute care spend for CHF w/MCC ranges from $10,000 to $17,500
18
Avg post acute care spend for CHF w/MCC among NJ hospitals ranges from $15,600 to $27,500
19
In a bundled payment model, a single provider is responsible for managing all aspects of care during a discrete episode. Provider as “Conductor”
Bundle Definition
DRG or procedure)
Target Price
the Target Price
Price
20
23,000 20,000
5,000 10,000 15,000 20,000 25,000
Target Price Avg Actual Costs
Inpatient Anchor Readmissions PAC Facility (LTACH, SNF, IRF) Home Health Part B (Prof & drugs) Hospital OP Other (OP, DME)
Providers earn additional revenue when actual costs are less than the target price (savings are in addition to traditional professional service billing) $3,000 savings per case kept by specialist
21
Anchor IP HHA IRF LTCH HOPD Readmissions SNF
bundle by reducing PAC utilization by 10 - 30%
– 38% of CHF bundles include a readmission; Avg readmissions per CHF bundle = $5.1k – Cardiologists could earn an additional $1k per CHF bundle by cutting readmissions by 20%
Physicians must have minimum % volume under risk arrangement
25% 25% 50% 50% 75% 75% 20% 20% 35% 35% 50% 50% 0% 10% 20% 30% 40% 50% 60% 70% 80% 2019 2020 2021 2022 2023 2024+
A-APM Track: Revenue and Patient Count Thresholds
Payments through Advanced APMs Patients in Advanced APMs
Medicare or All-Payer Options
Performance Year 2017 2018 2019 2020 2021 2022+
Medicare threshold calculation: Medicare Part B payments for bundle patients/ Total Medicare Part B payments
Medicare bundle patients / Total Medicare patients
Can include Medicare Advantage; denominator depends on participating providers
Medicare-only Option
Payment Year
23
24
1/1/2020
Ø Non binding application due March 12th for first start date
MACRA
(PGPs)
than recent open window periods
25
Patients Included:
all Medicare FFS beneficiaries
Patients Excluded:
Beneficiaries covered under Medicare Advantage or United Mine Workers or with Medicare as a secondary payers; ESRD eligible beneficiaries; beneficiaries who die during the Anchor Stay or Anchor Procedure
26
following the anchor stay/procedure, including:
, SNF , home health agency, Clinical lab, DME, Part B drugs, and hospice [new]
three days prior to the Anchor Stay
related care, organ transplants, ventricular shunts, blood clotting factors
27
Inpatient bundles anchored by MS-DRGs Ø 8 Cardiac: AMI, CHF, Cardiac arrhythmia, Cardiac defibrillator, Cardiac valve, CABG, Pacemaker, PCI
Ø 10 Ortho: MJRLE; MJRUE; Double JRLE; Fractures of femur/hip/pelvis; Hip & femur procedures except MJ; Lower extremity/ humerus procedure except hip, foot, femur; Spinal fusion (non-cervical); Cervical spinal fusion; Back & neck except spinal fusion; Combined anterior posterior spinal fusion Ø 3 GI: GI hemorrhage; GI obstruction, Major bowel procedure Ø 2 Respiratory: COPD, bronchitis, asthma; Simple pneumonia and respiratory infections Ø Other: Cellulitis; Renal failure; Sepsis; Stroke, UTI Ø New: Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis
Outpatient bundles identified by HCPCS
remove bundles on an annual basis IP bundles represent >55% of all IP expenditures, or $70+ billion in annual national spends. Under BPCI Advanced, this represents $2+ billion in savings for CMS and up to $15 billion of shared savings for providers
28
procedure is performed; the target price will be adjusted by PGP-specific adjustments
set retrospectively at the time of Reconciliation based on actual patient case mix
calculated based on a combination of historical Medicare FFS spending, adjusted to reflect the Episode Initiator’s efficiency relative to its peers over time, along with adjustments for patient characteristics and regional spending trends
Benchmark price:
3% discount to Benchmark Price (3% discount subject to change in future Model Years)
Target price:
29
receive a positive reconciliation amount (i.e. bonus payment)
receive a negative reconciliation amount (i.e. repayment to CMS)
30
Initiator, weighted by volume and measure, to generate Episode Initiator-specific Composite Quality Score (CQS)
amount
can adjust bonus or repayment
31
Claim-based measures required and collected by CMS starting 10/1/2018: 1. All-cause Hospital Readmission Measure required for all bundles 2. Advanced Care Plan required for all bundles 3. Perioperative Care: Selection of Prophylactic Antibiotic: 1st or 2nd Generation Cephalosporin 4. Hospital-Level Risk-Standardized Complication Rate Following Elective Primary THA/TKA 5. Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following CABG 6. Excess Days in Acute Care after Hospitalization AMI 7. AHRQ Patient Safety Indicators (PSI 90)
32
participants must report quality data by February 20 of the following year
must report on all applicable quality measures for all of 2020.
quality data by submitting non- binding application Claim-based measures required and collected by CMS starting 10/1/2018: 1. All-cause Hospital Readmission Measure required for all bundles 2. Advanced Care Plan required for all bundles 3. Perioperative Care: Selection of Prophylactic Antibiotic: 1st or 2nd Generation Cephalosporin 4. Hospital-Level Risk-Standardized Complication Rate Following Elective Primary THA/TKA 5. Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following CABG 6. Excess Days in Acute Care after Hospitalization AMI 7. AHRQ Patient Safety Indicators (PSI 90) Additional measures that may be required starting 1/1/2020 1. CAHPS for Clinicians 2. CAHPS for Hospitals 3. CAHPS Home Health Care 4. Hypertension: Improvement in Blood Pressure 5. Drug Regimen Review with Follow-up 6. Surgical Site Infection 7. Unplanned Reoperation within 30 Day Postop Period
33
Model (i.e. BPCI-Advanced)
BPCI Advanced participation
patients in risk arrangement
quality performance; two-sided risk increases from ±4% to ±9% over time
QPP forces physicians into
Medicare FFS payment tracks
BPCI Advanced will not qualify physicians for Advanced APMs track until MACRA Year 3, corresponding with Performance year 2019 and Payment Year 2020
34
MSSP Track 3, Vermont Allpayer ACO, ESRD Seamless Care Organization – For example, if an Episode Initiator participating the MJRLE bundle treats a beneficiary aligned to a Next Gen ACO, that case would not count in BPCI Advanced
1+, and 2
Advanced, but can participate in other bundles – CJR bundles take precedence over BPCI-A bundles
adjust OCM payments to account for overlap with BPCI Advanced
35
36
included in BPCI Advanced, representing 15% of total Medicare FFS IP spending
37
Anchor IP HHA IRF LTCH HOPD Readmissions SNF
bundle by reducing PAC utilization by 10 - 30%
– 32% of AMI bundles include a readmission; Avg readmissions per AMI bundle = $4.7 k – Cardiologists could earn an additional $1k per AMI bundle by cutting readmissions by 20%
38
Anchor IP HHA IRF LTCH HOPD Readmissions SNF
bundle by reducing PAC utilization by 10 - 30%
– Avg IRF spend per CABG bundle ~$1,900 – 18% of CABG bundles include a readmission; Avg readmissions spend per CABG bundle = $2.2k
39
40
MedAxiom
information
in evaluating
submitting non- binding LOI to CMS
Sign our Good Faith Agreement BPCI-A Application – Due March 12 Preliminary Opportunity Assessment
that explains how MedAxiom/Archway and your practice will engage to apply for BPCI-A
analysis on your
and opportunities using the Archway Analytics platform.
MedAxiom/ Archway to submit your application and request your data Contact Us
41
Episode Initiators (PGPs or hospitals) and bears and apportions financial risk
42
43
About your Group, Hospital or Program
strategies for these patient populations? Stakeholder Identification and Alignment
patients?
Clinical Strategy
and philosophy?
Operational Structure
capabilities?
44
ACC CV Summit February 22-24, 2018 www.acc.org/CVSummit2018 CV Transforum Spring’18 April 12-14, 2018 www.cvtransforum.com
46