From Michael R. Ripchinski, M.D.
, Chief Clinical Officer
Penn Medicine Lancaster General Hospital is now participating with the Centers for Medicare & Medicaid Services in a new voluntary episode payment model.
The Bundled Payments for Care Improvement Advanced
(BPCI-A) program includes 29 inpatient and three outpatient episodes for patients with traditional Medicare (not Medicare Advantage or commercial payers). The bundle includes the acute care episode or procedure and the 90-day post-acute period care and costs. The program started Oct. 1, 2018, and the performance period will run through December 2023. LGH is participating in the four episodes: sepsis, heart failure, stroke and hip/femur procedures except major joint.
Why are we participating, and what’s involved with BPCI-A?
The ultimate objective is to drive smarter spending through coordinated, high-quality care with improved patient experience. This program involves combining the payments for physician, hospitals, and other health-care provider services into a single bundled payment amount. This amount is calculated based on the expected costs of all items and services furnished to a beneficiary during an episode of care.
The quality measures
for LGH’s four bundle episodes are:
All-cause Hospital Readmissions calculated by CMS via claims
CMS Patient Safety Indicator-90 calculated by CMS via claims
Advance Care Plan as documented on physician/advanced practice clinician claims
Perioperative Care: Selection of Prophylactic Antibiotic: First or Second Generation Cephalosporin as calculated from Merit-based Incentive Payment System (MIPS) submission
How does this affect the Medical Staff?
The work to redesign care and reduce unnecessary variation will be coordinated through our quality and performance improvement structure, the Clinical Effectiveness Committees and Care Management Teams. These teams will coordinate with our partners, including Lancaster Rehabilitation Hospital, Affilia and our post-acute provider network of skilled nursing facilities. If you are already participating in this work, thank you! If you are interested in learning more, view the FAQs
or contact me.
Physicians do not hold any financial risk in this model. LGH’s participation in this program will not impact your professional billing payments from Medicare. However, BPCI Advanced qualifies as an Advanced APM and affords hospital-based physicians the opportunity to participate in an Advanced APM, providing new revenue opportunities and reduced reporting requirements under MIPS.
For more information, check out the links in this story or contact me
or at 717-544-5817.