The window has closed for BPCI Advanced- so what’s next?

Message from Walt Beaver, MD

OrthoCarolina Hip and Knee Center, Charlotte, NC    

As orthopaedic surgeons, we have the ability to drive change in value-based healthcare. It takes leadership and finding the right partner to move the needle, but when you do it, it feels good. The final opportunity to enroll in BPCI Advanced closed on June 24, 2019. However, those of you that are currently in the program, like us at OrthoCarolina, are in the trenches keeping a close eye on episode costs, educating patients that the best place to go after surgery is typically home, and anxiously awaiting our first CMS reconciliation payment. Fortunately, we have a few tools that help us to estimate our costs and track patients along their surgical journey so we can closely manage and monitor their post-acute care.

Stryker Performance Solutions’ Episode Performance Manager dashboard and RecoveryCOACH care coordination platform have been instrumental tools for our Care Navigation team. It is important to have a robust patient optimization program to make sure patients obtain quality results with the fewest complications possible, including readmissions. As participants in the BPCI program since 2015, we have learned how important it is to have a great partner as a convener. Allowing true healthcare reform experts to manage the administrative aspects of the program frees up our team to do what they do best -- care for patients. I have been thrilled with our choice of Stryker Performance Solutions as our convener. They have listened to our needs and quickly implemented improvements and innovations so we can obtain the best results possible for us.

Why does this matter? BPCI Advanced is just one value-based payment model, for Medicare patients only. Everything we learn and have learned to improve quality while reducing costs for the healthcare system can be applied to all patients. We have negotiated several bundles with commercial payors and are starting to find that negotiating with them is getting easier as they understand the value and savings a bundle can generate. We have found that managing commercial bundles is not easy unless you have the right tools and processes in place.

One big challenge has been maximizing the number of patients that opt-in to be a part of a commercial bundle. Stryker Performance Solutions developed a patient qualification checklist for commercial bundles that is helping us improve our workflow through automation. With reports generated through RecoveryCOACH, we are developing a systematic approach to managing commercial bundles that is making the staff more efficient and will continue to help us enroll more patients in our bundled payment programs.

If you missed the boat on BPCI Advanced, I suspect there will be a next time. CMMI will likely continue to test new episodic payment models and commercial payors will likely follow suit with continued expansion of bundled payment contracts. Rapid advancements in healthIT and data analytics may help us better predict outcomes and take us one step closer to population health.


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