Understanding BPCI A For Skilled Nursing Facilities

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1 Understanding BPCI A For Skilled Nursing Facilities February 20, 2018 Deanna L. Stephenson Director, Managed Programs

2 Learning Objectives Timeline for implementation How skilled nursing facilities will participate Criteria that skilled nursing facilities must meet for inclusion into initiative Describe model payment and pricing methodology

3 Bundled Payments for Care Improvement BPCI In 2013 The Centers for Medicare and Medicaid Innovation (CMMI) launched BPCI to test bundled payments with acute and post acute providers. 48 clinical episodes were involved. Episodes included inpatient acute care, 30,60 or episodes that included 90 days post discharge

4 CJR Comprehensive Care for Joint Replacement (CJR) In April MSA s (now 34) 48 clinical episodes were involved. Episodes included inpatient acute care, 30,60 or episodes that included 90 days post discharge

5 Episode Payment Models EPM s Short lived initiative announced in 2016 Tested 90 day bundled payment model for heart attack, bypass surgery, and hip /femur fracture treatment Initiative canceled in 2017

6 BPCI Advanced BPCI A Voluntary payment model Single payment and risk track with a 90 day episode period 29 Inpatient Clinical Episodes 3 Outpatient Clinical Episodes Qualifies as Advanced Alternative Payment Model, tied to performance on quality measures Preliminary pricing provided prospectively

7 BPCI A Objectives Care Redesign Data Analysis and Feedback Financial Accountability Health Care Provider Engagement Patient and Caregiver Engagement

8 Questions

9 What is Different between BPCI A and BPCI 1.0 BPCI A BPCI 1.0 Clinical Episodes 29 IP Episodes, 3 OP Episodes 48 IP conditions Episode Initiator Hospitals, Physician Groups Hospitals, Physician Groups, PAC Providers Episode duration 90 days 30,60 or 90 days Reconciliation Semi- annual Quarterly Pricing Prospective based on blend of historical and regional, risk adjusted Is Program Voluntary Yes Yes Risk Adjusted- tied to quality Yes No EHR technology required Yes problematic for PAC! Retrospective based on historical performance NOT risk adjusted

10 BPCI A Implementation Timeline GO LIVE October 1 st 2018 January 9 th - CMS Request for applications January 11 th Application portal opens March 12 th Application portal closes June 2018 CMS offers Participant Agreements to Applicants August 2018 Signed Participant Agreements due to CMS October 1 st GO LIVE January 1, 2020 Next application period

11 How do SNFs Participate in BPCI A Only hospitals and physician groups can initiate episodes under BPCI A. SNFs and other downstream providers can participate as NPRA (Net Payment Reconciliation Amount) Sharing Partners NPRA Sharing Partners can share risk with Convener and Episode Initiators (hospitals or physician groups) & with other downstream providers, physicians, accountable care groups and other PAC providers. NPRA payment capped at 50% of total Medicare FFS expenditure for the clinical episode.

12 3 Potential Roles SNFs Can Play in BPCI A 1. Preferred Referral Partner Supports Conveners/ Episode Initiators Part of preferred network for BPCI patients Do not assume financial risk 2. Risk Sharing Partner Supports Conveners /Episode Initiators Assume financial risk for BPCI patients Agreement may include SNF stay only or all PAC services 3. BPCI A Convener Directly Participates (most difficult) Assume financial risk for entire episode Identify and manage episode initiators

13 Preferred Referral Partner Receives patients from wide referral network Not a lot of experience in a risk environment Does not have strong market relationships Operate among peers in a competitive environment Maintains current referral sources in a live market without assuming any formal financial risk --- most safe

14 Risk Sharing Partner May be in relationships with physicians, ACOs and PAC providers MUST have a written agreement with convener or episode initiator Can accept risk for SNF stay or 90 day episode SNF can take a larger role and manage the entire PAC 90 day episode Can only share 50% of total Medicare FFS spending for clinical episode This is sharing financial risk ( upside and downside) - more risk

15 BPCI A Convener Contracts directly with CMS on behalf of Episode Initiators Must be able to provide proof of organizational ability to assume financial risk ( CMS provides specific amount) Must meet EHR requirements Implement care design initiatives specific to quality measures Report on all quality measures Be able to identify any and all sharing agreements This is most risk

16 Preferred Referral Partner Provide high quality SNF care SNF Evaluation Develop strong relationships with referral partners Risk Sharing Partner All the above + financial risk, achievement of goals and development of other downstream providers. BPCI A Convener All the above + manage hospital / physician group episode initiators, use EHR technology and manage claims data coming from CM

17 How to Be A Strategic SNF Identify hospitals and physicians that you have strong relationships with to create partnership and relationships You have got to know how your data works including trends and be able to compare yourself to your peers Develop a portfolio to be able to present all your strengths to other providers

18 What About BPCI Model 3? Model 3 made most sense for PAC providers to advance to Providers could actually formulate outcomes for patients and report to CMS Model 3 has 550 SNFs enrolled in BPCI Phase 2 The Ask: Make BPCI A more flexible in order to allow more SNF participation

19 BPCI A Cons Loses progress made in BPCI Model 3 Missed opportunities to create Physician SNF partnerships and prevent re-hospitalizations

20 Resources Questions on BPCI Application process: BPCI Additional Information:

21

22 Deanna Stephenson Director, Managed Programs

23

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