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Providers across the nation are achieving success in bundled payments, including those participating in the Bundled Payments for Care Improvement (BPCI) Advanced program.
In fact, organizations in Premier’s Bundled Payment Collaborative significantly outperform their peers in Medicare bundled payment programs, and the vast majority of them chose to stay the course with BPCI Advanced. Behind these efforts are successful gainsharing initiatives between physician practices and the health system that align performance improvement goals between organizations and their engaged physicians.
Because BPCI Advanced is the latest voluntary bundled payment program, providers are more knowledgeable about the opportunities to share savings than ever before. Today, participants in BPCI Advanced know which clinical episodes they should stick with long-term and many have engaged in efforts to incentivize performance with their physicians and post-acute providers through gainsharing. And while gainsharing (called Net Payment Reconciliation Amount (NPRA) Sharing in BPCI Advanced) isn’t as new of a concept as it was five years ago, physicians understand the potential and are keen to know the opportunities that exist for them – meaning they are upping the pressure on hospitals to gainshare.
For those participating in BPCI Advanced, specifically, now is the time to engage with physicians and post-acute care providers who deliver high-quality care and can help organizations achieve savings in the model.
The episode attribution rules in the BPCI Advanced program allow physicians (attending and operating) to take precedence over hospital participants. As a hospital, engaging physicians for gainsharing now may mean your organization keeps the episode volume while still providing the desirable financial incentives to providers. However, gainsharing is a slightly different world today than in prior Medicare bundled payment programs, and understanding how to use these rules advantageously will be key to success.
For example:
It’s important to take time considering which specialties will work best with an organization’s bundle patients and which may have the biggest impact of episode cost. This requires exploring which physicians interact with patients most often and have the most influence over their care. Sometimes this is clear cut, such as a surgeon for a procedural bundle. But bundles get muddier when a variety of different specialists support the patient mix.
Additionally, more hospital participants are in medical/non-procedural bundles than in the prior voluntary BPCI program. This means gainsharing may not occur with only one specialty as is normally done with procedural bundles (i.e., gainsharing with orthopedic surgeons in a joint replacement bundle).
Consider deploying a ‘team based’ gainsharing program that allows the organization to gainshare with multiple specialties at once. This brings key players to the table and allows providers to maximize their alignment efforts.
To make educated decisions on the performance measures gainsharers should be held to, use baseline data and the first few months of claims data from Medicare to understand patterns in post-acute care utilization and provider trends.
Involving physicians and post-acute care providers in care redesign efforts now will help to get their buy-in to promote better, more cohesive patient care in the future. As such, physicians will be more educated on performance metrics as well as overall episodic costs that will be part of the organization’s evolution toward change.
Gainsharing is a significant and powerful way for risk-bearing entities to entice better provider performance and fuel success in a bundled payment program. To learn more about the capabilities needed to succeed in BPCI Advanced, check out Ready, Risk, Reward: Keys to Success in Bundled Payments and visit www.premierinc.com/bp.