Readmits may be higher for bundled care payments: Avalere

• Readmission rates for conditions that are a part of the Bundled Payment for Care Improvement Advanced (BPCI-A) payment model can vary by up to six times, according to a new report from Avalere.
• The study found that 90-day readmission rates in 2017 were highest for certain liver disorders (43%) and lowest for major joint replacements of upper extremity (7%). The average across the conditions studied was 26%. Rate of readmission is one of seven quality measures the CMS bundled model uses to determine eligibility for bonus payments.
• The first group of BPCI-A participants will begin the model on Oct. 1, and the deadline for the second cohort of applications is Aug. 1.

Bundled payment models are a focal area for the movement toward value-based reimbursement. Although data show mixed success in reducing costs and improving health outcomes, multiple payers and providers are pursuing these models in the hopes of finding a successful and scalable method.

Avalere said that organizations participating in BPCI-A could use the readmission rate information to focus improvement efforts on certain conditions, and not necessarily surgical episodes typically targeted in readmissions. “In our experience, organizations that more carefully evaluate and select episodes for participation tend to be more successful in episodic bundled payment programs,” Erica Breese, director at Avalere, said in a statement.

CMS launched the much-anticipated BPCI-A in January as a voluntary model that includes 32 clinical episodes, three of which are outpatient. It builds off the original BCPI, which the Center for Medicare and Medicaid Innovation (CMMI) began in 2013 and has grown to include more than 400 organizations.

The original BPCI produced scattered results, and evaluation has been difficult because of numerous variables and options available under the model. One outcome CMS will hope not to reproduce was a relative lack of interest. Only 12% of eligible hospitals signed up for BCPI and nearly half of them dropped out for at least one condition, according to a report from JAMA.

One overall sticking point for bundled programs is whether they need to be mandatory to show improvement. It was no surprise that CMS chose to leave BCPI-A as voluntary, considering current management’s focus on avoiding excessive reporting burdens, but some policy experts still believe forced participation is necessary.

As more groups join BPCI-A, there is also concern it will overlap with other advanced payment models, particularly the Medicare Shared Savings Program (MSSP). If CMS does not address the issue, there could be “far-reaching impact on provider incentives and behavior,” according to a Health Affairs blog post last month.

That same worry was echoed recently in comments on CMMI’s proposal for direct provider contracting. The American Medical Group Association suggested CMS focus on fixing MSSP’s flaws instead of pursuing other, potentially redundant models.

Healthcare organizations are realizing the question they face is not whether to participate in value-based payment, but what method will work best for them.

As Darcie Hurteau, senior director of informatics at the policy and analytics firm DataGen told Healthcare Dive earlier this year, “This is the direction the industry is headed in, and practices will need to pay attention if they want to stay competitive.”

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