Review of CMS' Open Door Forum

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Yesterday, CMS held its first Open Door Forum about the recently announced new voluntary program, BPCI Advanced. We joined the Forum and are sharing our five key takeaways from the event with you. Archway will be providing additional detail during our upcoming webinar on Wednesday, Jan. 31 at 2 pm EST.

1. Public interest is very strong.
CMS received more than 600 questions about BPCI Advanced leading up to the Open Door Forum.

2. In the next few weeks, CMS will release details on the following program components:   
Target Pricing: During the Open Door Forum, CMS outlined the intricacies of the updated target pricing methodology, which will no longer be based solely on a provider’s historical costs. New adjustments will incorporate:

  • Patient comorbidities through the use of HCC risk factors
  • Peer group characteristics based on the 9 US Census Regions
  • Peer Adjusted Trend (PAT) Factor to replace the BPCI Trend Factor
  • Regression model for added risk adjustments

CMS’s incorporation of HCC risk factors and regression modeling resonates with the pricing methodology for CMS’ cancer bundle program, the Oncology Care Model, in which Archway has deep experience.

CMS also announced it will adjust Major Joint Replacement of the Lower Extremity (MJRLE) target prices for fracture status, and will soon release more detail on how Total Knee Arthroplasty in the hospital outpatient setting will impact target prices for the inpatient MJRLE bundle. Archway was excited to learn that CMS will release detailed specifications about the new target pricing methodology in the next few weeks; we will provide our insights on the new methodology shortly after its release. 

Composite Quality Score (CQS): CMS announced its plan to provide more detail on how the CQS will be calculated for program participants in the next few weeks.

3. The most common questions CMS received were related to CJR program hierarchy.
CMS reiterated that CJR takes precedence over BPCI Advanced for the assignment of MJRLE bundles.

4. Outpatient bundle anchor setting.
CMS confirmed that OP bundles can only be triggered in the hospital outpatient department setting.

5. Baseline period.
CMS announced that the baseline period used to calculate benchmark costs will be a four-year period from January 1, 2013 to December 31, 2016. Applicants who request data through the application process will receive three years of data, January 1, 2014 to December 31, 2016. In preparation of this program, Archway has purchased more than five years of Medicare claims data, including 2013, and can help providers understand their performance during the full, four-year baseline period.

Lastly, CMS has scheduled a second Open Door Forum, to be held on Thursday, Feb. 15 from 12 pm to 1 pm EST. Registration is now open.

To learn more about BPCI Advanced and evaluate your opportunity in the program, please contact Archway today.