MACRA

Archway Health Introduces Archway Academy to Educate Providers on BPCI Advanced

Free online learning platform addresses new CMS bundled payments program

The Centers for Medicare & Medicaid Services (CMS) recently announced the next generation of the Bundled Payments Care Improvement (BPCI) voluntary payment model, BPCI Advanced. The release of the updated program details officially opened a two-month enrollment window, set to close on March 12. To guide providers in this critical phase, Archway Health, a full-service tech-enabled bundled payment company, today unveiled Archway Academy, an online educational platform designed to help providers succeed in BPCI Advanced.

“Whether a practice has previous experience with bundled payments or is just starting to explore the option, Archway Academy will prepare them for taking the next step with BPCI Advanced,” said Keely Macmillan, Archway Health’s General Manager of BPCI Advanced. “We strongly feel that as the industry builds momentum toward implementing alternative payment models, providers need an unbiased space for learning about how they work and clear guidance through the process.”

Archway Academy provides a self-paced, online learning platform for healthcare practices and organizations that matches their demanding schedules and mission to improve both patient care and financial performance. The Academy helps answer clinicians’ questions on fit, function, costs and return on investment in the adoption of bundled payments for their practices. Further, Archway can handle the application process and data processing for providers interested in participating in BPCI Advanced.

“There are demonstrable benefits for specialty providers, large or small, to move to bundled payment models,” said Dave Terry, CEO and Co-founder Archway. “With Archway Academy, we can help clinicians and staff assess their opportunity for improvement, and importantly, make the application and implementation process far less intimidating and disruptive.”

Any provider who signs Archway’s non-binding Good Faith Agreement will gain full access to Archway Academy. In addition, Archway will be offering weekly webinars to provide updates on BPCI Advanced as more information is released from CMS. The next webinar will be Thursday, January 25 at 1 p.m. EST. Archway will also host a webinar on Wednesday, January 31 at 2 p.m. EST, following CMS’ Open Door Forum on January 30.

Can’t attend? Contact us directly and we’ll provide a link to the recording. 

For assistance with beginning the BPCI Advanced application process, contact us today.

CMS Testing Episode Cost Measures for Future Payment Program

As the healthcare industry continues to innovate, the Centers for Medicare & Medicaid Services (CMS) is charging forward to test and roll out new payment models. In October, CMS announced the field testing of eight, physician-driven bundles that could be used in the cost performance category under the Merit-based Incentive Payment System (MIPS) in the future. While MIPS may be on the chopping block, do we really think that’s likely to happen?   Previous CMS testing gives us reason to believe that CMS may incorporate its findings into future bundled payment programs.  

The eight episode cost measures include:

1.     Elective Outpatient Percutaneous Coronary Intervention (PCI)
2.     Knee Arthroplasty
3.     Revascularization for Lower Extremity Chronic Critical Limb Ischemia
4.     Routine Cataract Removal with Intraocular Lens (IOL) Implantation
5.     Screening/Surveillance Colonoscopy
6.     Intracranial Hemorrhage or Cerebral Infarction
7.     Simple Pneumonia with Hospitalization
8.     ST-Elevation Myocardial Infarction (STEMI) with (PCI)

CMS released specifications for the bundles including new trigger site criteria; some of these bundles also include pre-trigger periods ranging from 30 – 60 days.  

Before we expand further on this topic, let us pause to acknowledge that your experience is important, and CMS wants to hear from you. Share your feedback through an easy, online survey on these test measures by November 15, 2017.

Another Win For Physicians

In all of these episode-based cost measures, or bundles, the episode is attributed to a physician. This confirms and reinforces the priorities outlined in the RFI released in September concerning the Center Medicare and Medicaid Innovation (CMMI) “new direction.” The content of the RFI strongly suggested the prioritization of physician-driven models, and CMS continues to reaffirm its commitment with the field testing of these new physician-focused cost measures. Like CMS, we see value in this approach as evidenced by our experience. Bundled programs can be successfully utilized across the continuum of care, however, specialist providers are among the group to most consistently demonstrate value when owning the bundle.

Outpatient Bundles

For five of the eight bundles, the trigger event can take place in an ambulatory setting, indicating CMS is exploring the implementation of outpatient bundles. Ambulatory bundles have been an untapped source of savings for CMS. These bundles are more conducive to physician-driven, value-based care, and eliminate the reliance on MS-DRG assignment, which has been a challenge for Bundled Payments for Care Improvement (BPCI) participants. Adoption of the outpatient knee arthroplasty measure was contingent on CMS’ decision to pay for the procedure in the hospital outpatient department setting, which CMS confirmed it would on November 1, 2017.  Field testing of outpatient bundles also helps inform improvements in the physician attribution process, improvements which may be adopted in the next generation of BPCI.

New physician attribution

CMS is also exploring an alternative attribution methodology for the new inpatient-anchored bundles it is testing. In the current BPCI program, bundles are attributed to the attending or operating physician on the inpatient claim. CMS has intimated that hospitalists being assigned the bundle was an unintended consequence of the program’s design.  

For the new bundles triggered by an inpatient admission, the attributed clinician is the clinician who renders at least 30% of the evaluation and management services provided during a hospitalization. It is clear that hospitalists, who care for patients while in the hospital, are not the best-suited providers to care for a patient 30-60-90 days after discharge, and this new method may reveal opportunities for improvement in upcoming programs.  

How to Participate

Archway is glad to see CMS moving full speed ahead in developing physician-focused innovative payment models. Regardless of how the MIPS final rules work, we are pleased to see CMS learning from past programs to enhance future advancements in alternative payment models.

Share your feedback with CMS by November 15, 2017.

We also strongly urge physicians to access confidential feedback reports on these measures. For those participating in any of the eight bundles above, you may be able to view your Field Test Report on the CMS Enterprise Portal. There is further information on the MACRA site. If you need any help understanding your data and reports, please contact us at info@archway.com to arrange a one-on-one discussion.

Navigating MACRA: Comparing MIPS Versus APM for Specialists

January 1, 2017 marked the start of the first year of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP). More than halfway through the first performance year, many specialists are still trying to navigate participation, and one of the main questions is which payment track to pursue. MACRA, which was signed into law in 2015, was established to accelerate efforts to reimburse clinicians based on quality of care, instead of volume of care. To comply with the law, physicians must enter one of the two QPP value-based payment tracks: MIPS or Advanced APMs.

Track 1: MIPS

Merit-Based Incentive Payment System (MIPS) is a payment system under which physicians receive positive, negative, or neutral payment adjustments for their performance in selected quality measures. The track requires reporting in four performance categories: Quality, Advancing Care Information through Health Information Technology, Clinical Practice Improvement Activities, and Resource Use. MIPS must be budget-neutral to Medicare on an annual basis, such that bonuses paid to relatively high performing physicians must be equally offset by penalties applied to relatively low performing physicians.

Track 2: Advanced APMs

The second track is Advanced Alternative Payment Models (APMs). For most specialists, participation in the upcoming next generation of Bundled Payments for Care Improvement (BPCI) will be the first opportunity to qualify for the Advanced APMs track. Participants who have sufficient revenue or patients in an Advanced APM will receive an automatic 5% payment bonus with the opportunity to earn even more if they achieve savings targets under BPCI.

The Next Opportunity For Track 2: BPCI Advanced

It is important to note the two-year lag under both QPP payment tracks such that clinician reimbursement in 2019, MACRA’s first payment year, is based on performance during 2017.  To qualify for the Advanced APMs track in payment year 2020, providers must begin participating in an Advanced APM in 2018.

With the MACRA QPP’s second payment year fast approaching, providers should think strategically about which track they should pursue. Of the two tracks, we at Archway believe the Advanced APM track is more advantageous for specialty-focused providers. While physicians are forced to accept downside risk under an APM arrangement, there are clear benefits: better access to performance data through the Center for Medicare & Medicaid Innovation (CMMI) to implement care improvement initiatives, the opportunity to receive a 5% lump sum bonus under MACRA (regardless of performance in the Advanced APM) and avoidance of downside risk and additional quality reporting requirements under MIPS. Conversely, MIPS offers limited upside potential due to the forced-ranking mechanism applied by CMS to achieve budget neutrality, as well as a diminished incentive pool resulting from broadened MIPS exclusionary criteria.

At Archway, we believe qualifying for the Advanced APMs track though participation in the next generation BPCI program is not only the better option under MACRA’s QPP, it’s a better business solution. Bundled payments can help grow your practice, and Archway is the partner to help you navigate these bundled payment programs.