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Episode Payment Models: CJR Results and BPCI Advanced Opportunities
Episode Payment Models: CJR Results and BPCI Advanced Opportunities
CCMS recently released Comprehensive Care for Joint Replacement (CJR) model results for Performance Year 1 (episodes with start dates between April 1st and September 30, 2016 and end dates on or before December 31st, 2016.) The CJR model is a mandatory bundled payment model in which 799 participating hospitals from 67 metropolitan statistical areas (MSAs) were originally required to participate.

Milliman has analyzed the Performance Year 1 results, examining hospital financial performance and quality performance metrics. They have calculated average reconciliation payment amounts per episode by quality performance categories, and addressed distribution of payment status by hospital size as well as applicable DRG (469 and 470) volume.

In addition to the implications of the CJR model results, introduction of a new significant episode payment model demands the attention of stakeholders going forward. CMS recently announced a new voluntary episode payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced) that will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program established by MACRA.

BPCI Advanced will initially test bundled payments for 32 Clinical Episodes (29 inpatient and 3 outpatient) but CMS may elect to revise the Clinical Episodes in BPCI Advanced on an annual basis beginning in 2020. Participants selected to participate in BPCI Advanced beginning on October 1, 2018, must commit to be held accountable for one or more Clinical Episodes and may not add or drop such Clinical Episodes until January 1, 2020. Deciding whether or not to apply to BPCI Advanced is a key question for many stakeholders, and decisions must be made quickly as applications are due March 12, 2018.

Please join us Wednesday, February 28, 2018 at 1 PM Eastern as Milliman's Pamela Pelizzari discusses CJR performance year one results and insights, requirements, challenges and opportunities regarding the newly announced BPCI Advanced Program.
Click here for detailed information and to register or call 209.577.4888.
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