EPM

Cancellation of Mandatory Bundles Paves the Way for Voluntary Success

This week, the Centers for Medicare & Medicaid Services (CMS) announced it will cancel its mandatory cardiac and orthopedic Episode Payment Models (EPM), in addition to scaling back the Comprehensive Care for Joint Replacement (CJR) model. While the news has left some questioning the future of value-based care, the cancellation of these mandatory bundled payment programs is a favorable indication of the future of voluntary reimbursement programs.   The recent cancellation of mandatory bundles has been brewing for some time. Prior to the cancellations, Tom Price, Secretary of the U.S. Department of Health and Human Services delayed the effective start date of EPM, and openly criticized the mandated programs. And while it may seem that bundled payments have been through the fire in just a few short days, two voluntary models that have seen much success among providers have emerged unscathed: Bundled Payments for Care Improvement (BPCI) initiative and Oncology Care Model (OCM).

Even when mandated programs were in place, hospitals and other stakeholders were pressing for voluntary initiatives. Results from the voluntary programs have shown greater engagement and increased savings among providers who are eager to improve quality and reduce costs in a pressured healthcare environment. As success of the voluntary models continues, we expect the adoption of these programs will only continue to grow.

At Archway, we have a rather unique opinion on the recent news and the mandatory versus voluntary debate. As a bundled payment company, one would likely assume we are in favor of mandatory bundled payment participation. In fact, we believe the best approach for bundled payment programs is to allow voluntary participation.

While we were initially excited about the CJR and EPM programs that included mandatory participation for certain areas and hospitals, we have concluded over the past two years that voluntary programs will have a bigger and more rapid impact on the shift from volume to value.

Even better news in the announcement this week is the clear indication that CMS is moving full speed ahead with a new voluntary bundled payment program that will allow hospitals, specialists and post-acute providers to serve as Episode Initiators. We view this as a very positive development for providers who missed the last voluntary open enrollment period in early 2014.  This program will also enable CMS to offer an opportunity for specialists to participate in a MACRA qualifying Advanced Alternative Payment Model (APM) in 2018.

As CMS prepares to launch the next generation of BPCI in the coming weeks, we’ve actively advocated for the program to be voluntary. There are three main reasons why we believe voluntary bundled payment programs will be more successful in this transition:

The first is the willingness of providers to commit to payment reform. Because they have signed up, provider organizations participating in the voluntary programs are more engaged and motivated to change processes, improve care, and reduce costs. As a result, the improvements are more significant and the adoption occurs more rapidly.

The second is that voluntary programs don’t have to appeal to all providers. In order to make mandatory programs palatable to reluctant participants, the rules tend to be watered down compared to the rules within the voluntary programs. As a result, there is less urgency to change behavior, and the improvements in care and cost are not as substantial.

Finally, we have seen many specialty groups, hospitals and post-acute providers achieve significant success in these voluntary initiatives.  In the programs we have helped manage, we have seen outcomes improve, patients return home faster, and significant savings earned by both CMS and the Episode Initiating providers.

Even in losing these mandatory bundled payment programs, CMS continues to push the industry toward value. By having voluntary participants show the benefits and significant improvements from bundle payment programs, more providers will eventually want to participate, and we are confident we will see a more impactful shift in payment reform.

Upcoming Conferences: CV Transforum and AAOE

Archway Health will be presenting and exhibiting at two upcoming conferences in April. CV Transforum

CV Transforum will take place Tuesday, April 18th through Thursday, April 20th at the Ritz-Carlton, Amelia Island, Florida.

Ed Bassin, PhD, Archway Health Chief Analytics Officer, and Dave Terry, Archway Health Founder and CEO, will speak at a CV Transforum pre-conference session titled "EPM (Bundled Payments) Boot Camp." Also speaking at the session are Anne Beekman, RN, Vice President, MedAxiom Consulting; Ginger Biesbrock, PA-C, MPH, MPAS, AACC, Vice President, MedAxiom Consulting; Tim Kennedy, Shareholder, Hall, Render, Killian, Heath & Lyman, P.C; and Joel Sauer, Vice President, MedAxiom Consulting.

From the CV Transforum agenda:

On December 20, 2016, CMS published the final rule, Advancing Care through Episode Payment Models and Cardiac Rehabilitation Incentive Model. CMS’ stated goals of this rule is to improve quality of care in the applicable episodes, while reducing episode spending through financial accountability.

This intensive, small group boot camp session will allow for depth of discussion and very detailed information sharing on everything you need to know about the final rule. We will provide expert clinical, financial and legal education so you can learn how to benefit from it whether in a chosen MSA or not. This essential boot camp will hit all of the important components of this new rule and the implications to AMI and CABG episodes. Our expert policy, legal and consulting panel will bring valuable insights around the complexities of the rule and discuss how to leverage it while improving the quality of care you provide.

Topics to be covered include:

  • Final Rule Summary
  • Review of the MedAxiom EPM Data
  • Clinical Needs Inside Bundles (pathways, standardization)
  • Infrastructure & Alignment Requirements (governance, leadership, physician comp)
  • Importance of Coding & Documentation
  • Legal Update (acceptable gain sharing arrangements)
  • Q&A

Whether you are in a chosen MSA or not, and regardless of what the new administration does, EPMs and value-based medicine is the inevitable future of health care. Stay ahead of the curve and be prepared for the future by participating in this essential bundled payment educational event.

Learn more about the Spring '17 CV Transforum and register here: http://cvtransforum.com/

 

AAOE Annual Conference

Archway Health will also be at the AAOE (American Alliance of Orthopedic Executives) Annual Conference, which takes place at the JW Marriott Hotel, Indianapolis, Indiana from Saturday, April 22nd to Tuesday, April 25th.

From the conference website:

The AAOE Annual Conference brings together more than 500 orthopaedic practice executives and their staff from around the country for four days of education, networking, and professional development. The conference allows practice professionals to stay up-to-date on the latest industry trends while networking and learning alongside peers.

Learn more about the AAOE Annual Conference and register here: http://s4.goeshow.com/aaoe/annual/2017/index.cfm

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