In other words, we’re still bundling payments.
BPCI Advanced Model is also referred to as Advanced Alternative Payment Model and will officially start enrolling patients in October 2018 and will run through the end of 2023.
But, and this is key, it will incentivize more outpatient (and presumably less expensive) care.
Is CMS Putting Doctors (or Patients) at Risk?
Wilford K. Gibson, M.D., chair of the American Association of Orthopaedic Surgeons’ Council on Advocacy expressed both support and reservations.
In terms of CMS, Dr. Gibson said, “We will continue to work with CMS to increase opportunities for specialty participation within the Quality Payment Program and to ensure that physician payment reform ultimately improves the care of musculoskeletal patients.”
But, in terms of the BPCI, he said, “Medicare will be saving millions, but doctors are at risk due to the payment method. There are some winners and some losers with the new model.”
He added, “If you are a traditional Medicare patient, you will not see much difference, but the hospital stay will be curtailed, and more emphasis will be placed on rehab at home. They are emphasizing home care in order to cut costs for better outcomes.”
“We hope that BPCI Advanced will improve and coordinate patient care while qualifying orthopedic surgeons under the Advanced APM track. BPCI Advanced has some difficulties and risks for physicians. The new model has some risk but also potential for gain as target price is fixed”.
Will Private Payors Follow CMS’s Lead?
UnitedHealthcare, the largest private payer, told OTW, “We’ve seen a positive response from physicians to value-based care models, including bundled payments. That is validated by the fact that UnitedHealthcare‘s provider reimbursements that are tied to a variety of value-based care arrangements have nearly tripled in the last three years to $64 billion annually and are expected to reach $75 billion by the end of 2020.”
He added, “To date, more than 15 million people, or nearly one in every three people enrolled in UnitedHealthcare benefit plans, currently access care from providers in value-based care relationships.”
“It is important that we remain flexible with care providers because there isn’t a ‘one size fits all’ approach. We’re able to meet individual care providers where they are in terms of their readiness to shift to value-based programs and help them succeed. He added, “Having some form of shared risk really activates the relationship because the care providers are more engaged, and we see both quality and efficiency improve.”
Dr. Daniel Murray, who is Chief Medical Officer for OptumCare, a subsidiary of UnitedHealth Group, Inc. spoke about this strategy at the AAOS round table conference. He explained how he aligned incentives for optimized care and lowered cost as a CEO/spine surgeon at OrthoCarolina Surgical Group. He also shared that through better understanding of patient needs/advocacy, he was able to reduce cost 30% and reduce complications by 30%.
Additionally, Dr. Murray discussed procedures and programs that increased patient care, while lowering costs utilizing innovative payment models. He also talked about substantial changes in Comprehensive Care for Joint Replacement precedence in the new model.
