July 10 2018 BY: Sarah Chen, MD

BPCI-A “Try Before You Buy” – Risk Free!

As many were celebrating the 4th of July holiday, CMS announced extensions of a few key deadlines and updates to Bundled Payment for Care Improvement Advanced Program (BPCI-A). Most notably, CMS will allow all participants to retroactively withdraw Episode Initiators (EIs) and/or Clinical Episodes in March 2019. Here’s what you need to know:

TRY BEFORE YOU BUY: This one-time opportunity to “opt-out” gives you an extended six-month window to try out additional episodes you may not have previously considered. In February 2019, CMS will redistribute Participant Profiles – this will be the time to retroactively withdraw from participation for Model Years 1 & 2 (2018 & 2019) so that you are not being held accountable for episodes triggered during this period.

ACCESS TO YOUR DATA: If you choose not to opt-in, you’re missing out on recent claims data that your competitors will be receiving through March 2019. Not to mention, opting in will better position you to apply for the next window of the Model in January 2020.

IMPROVEMENT STILL REIGNS SUPREME: The quicker you get going on care redesign, the more time you’ll have to leverage actionable insights to drive change to achieve a bonus.

THE GAME IS STILL ON: CMS’ updated timeline remains. Don’t forget these important dates:

  • August 8, 2018 – Signed participation agreements and clinical episode selection due
  • September 14, 2018 – New due date for program deliverables
  • October 1, 2018 – Initial start date remains

Even with additional time, many providers will struggle to project their future performance because they have only been given historical data through 2016. Clarify has more recent data on your performance and provides customers with a continuous projection of their bonus or penalty based on real-time target price calculation. You will need to demystify how you’re likely to perform once the program starts. To do that you’ll need the most advanced analytics and a deep understanding of CMS’ rules.

If you have questions about what the March 2019 withdrawal could mean for your business, Clarify is here to help. Our unparalleled Clinical Transformation and Implementation team, made up of clinicians with operational and business experience, is here to advise and guide on whether or not you want to enter new episodes. Contact me at [email protected].

Don’t forget to check out our BPCI Advanced Insights eBook: get your copy!

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