Shared Savings versus CMS Bundled Payments Model: A No-Risk Alternative
- June 13, 2018
- Posted by: dynafios
- Category: Blog, Healthcare Consulting, Hospital Management, Shared Savings
Hospitals and physician groups wanting to participate in the new CMS Medicare BPCI Advanced demonstration are now on edge as the agency promised to give providers the claims data they need to decide which care bundles to select. It’s now June and provider groups that applied to participate in the voluntary Bundled Payment for Care Improvement Advanced (BPCI) program are just getting data with limited time to truly understand the risks associated with the program. With the program starting in October and running through 2023, there isn’t much time for organizations to analyze all the variables that impact making a good decision.
On Monday, June 4, the agency began transmitting data to applicants on target prices it will pay for each bundled episode of care. However, the agency has not sent applicants the claims data. As of this writing, CMS had yet to disclose how many provider groups submitted applications by the March 12 deadline.
Applicants now have a time crunch due to the delay in receiving claims data. Providers must tell CMS which of the 32 bundled-payment clinical episodes they want to participate in by August 1—that’s in just 7 weeks. Providers need to see their past Medicare claims data to determine how financially viable it would be to participate in the different bundles. Providers can drop out partly or entirely should they choose.
CMS has sent an email to applicants that it had transmitted a large portion of applicants’ pricing data. CMS stated it would finish sending the files and will “work towards providing raw claims files.”
Under BPCI Advanced, CMS will pay providers a fixed price for an episode of care, with the price announced in advance. An episode begins with an initial hospital admission or outpatient procedure and includes all care during the next 90 days.
Now, you have to wonder, is all of this worth it?
Consider a Shared Savings program instead.
Late last year, the Office of the Inspector General (OIG) issued an Advisory Opinion on Shared Savings programs. To cut to the chase, the OIG identified key elements for a Shared Savings Program that would be seen as favorable. Dynafios has created a Shared Savings program that includes these elements.
Dynafios Shared Savings program is a compliant, comprehensive and viable alternative to the CMS Bundled Payment for Care Improvement Advanced program. Plus, the Dynafios Shared Savings program does not involve combing through reams of claim data and avoids the bundled-payment selection chaos.
The Dynafios Shared Savings program is:
- Managed by us for a three-year term (required by law).
- Provides a cost and quality baseline analysis with a total savings goal.
- Once initiated, the program is monitored and managed with savings shared on a 50/50 basis with those physicians involved less administrative fees.
- Continually monitored to ensure all elements of the agreement are compliant with state and federal laws and ensures the payout is distributed on a per capita basis within the physician group.
- Involves all payor types—not just Medicare.
Shared Savings is no fuss, no muss. It’s straight-forward and can be initiated quickly. There is no risk to the hospital or practice and the results are always positive. Intrigued?
Free yourself of the BPCI Advanced confusion. Get more information on Dynafios Shared Savings, a hassle-free alternative to BPCI Advanced. Read more on Dynafios Shared Savings, give us a call at 887.858.3282 or fill out the form below and we’ll send you more information.