For BPCI Advanced Model Year 3, some recently announced program updates will bring more incentives and value to all participants – particularly cardiologists. These changes reward cardiology providers for making the best decisions for patients. We commend CMS for better aligning financial incentives with improved care, and we are proud to have advocated to CMS for both of these changes.
For the 175 practices participating in OCM, reconciliation reports are the moment of truth for each performance period in value-based payment programs. These reports reveal whether or not providers have beat their target prices and earned a Performance-Based Payment (PBP). But, PP4 isn’t all about the potential to bring in more revenue. Participants’ PP4 performance will bear much weight in determining whether they will be required to take downside risk to remain in the program moving forward.
Beginning with the start of Model Year 3 on January 1, 2020, when providers in Enhanced ACOs treat patients in a BPCI Advanced bundle, the BPCI-A bundle patient will be attributed to the owner of the bundle and not the ACO. This is an amendment to earlier CMS policy, which attributed these patients to the Track 3 ACO. NextGen ACOs will still take precedence over the BPCI-A program.
Clinical care is an essential aspect of any successful bundled payment program, and participating providers should work to include their clinicians. In the second installment of our Advice for Bundled Payments blog series, we sat down with two members of our clinical care team; Kemi Okunade and Aimée Bailey. We asked Kemi and Aimée how providers can engage clinicians in their bundled payment program and what to consider when starting a new program.