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Frequently Asked Questions about BPCI-A

 

1. What is the simplest way for a bariatric surgeon enroll to participate in BPCI-A?

Provide your Tax Identification Number, (TIN) to a Convener, (e.g. to Leavitt Risk) along with 9 simple questions regarding your contact information.

2. What is the most complicated way for a bariatric surgeon to participate in BPCI-A?

Apply to become a Convener, (26 page application form, background and legal check).

3. I have a new bariatric surgeon who has come from another local hospital. He will not have many cases from our hospital from which CMS can pull data. Our plan was to enroll our other two surgeons as an acute care facility, but should my new surgeon enroll as a private physician? I will not be able to get is previous employers CMS number etc.

Enroll your new bariatric surgeon along with the other two surgeons.  All three with the Acute Care Hospital.

4. Does BPCI-A apply to only patients with straight Medicare, or does it apply to replacement plans, (Medicare Advantage) as well?

Yes only ‘straight Medicare’.   Medicare Advantage plans are not included.

5. What is the projected cost per case for downstream protection through LRP?

The cost will be determined on receipt and analysis of the Target Price, (TP) data and will be expressed as a % of the TP.   Each Episode Initiator, (EI) or bariatric surgeon enrolled with LRP, will receive a detailed analysis of their TP along with a cost proposal from LRP.

6. Do Conveners get paid from Medicare?

Yes, Medicare pays the Convener and the Convener pays the downstream EI according to the terms of their agreement.

7. Once you enroll as a Participant, can you withdraw your Participation at a later date?

Enrolling now as an EI on a convener application before June 24, 2019 has no commitment for further participation. Once the Participation Agreement has been signed (November 2019), it is possible to withdraw, however limitations and restrictions do apply. Contact LRP at bpcia@leavittrisk.com for details.

8. What is the upside or downside to either participate or not when very minimal data is available?

Participation is always voluntary.   LRP recommends bariatric surgeons enroll to participate as an EI on at least two or more Conveners in order to see their data regardless of past volume.   The data will be extremely valuable as it will tell the bariatric surgeon a great deal about where their outcomes fit in their market.   Understanding this will allow the surgeon to position themselves in their market for what is expected to be the future expansion of this type of payment model into the Commercial payer market and perhaps a mandatory Medicare model.

9. What is the difference between enrolling with Leavitt Risk Partners and enrolling directly with Medicare? Is it the BLISCare protection additional feature?

See Q’s 1 and 2.  Time and expense are the two key differences.   BLISCare downside protection is included when the EI enrolls to participate with LRP as Convener.    Costs are deferred until the Medicare process is completed several months later.  BLISCare is also available to the broader market however the cost must be paid at the time cases are performed.

10. If I do very few Medicare patients, is it needed to participate?

Participation is always voluntary. LRP recommends bariatric surgeons enroll to participate as an EI on at least two or more Conveners in order to see their data regardless of past volume. The data will be extremely valuable as it will tell the bariatric surgeon a great deal about where their outcomes fit in their market. Understanding this will allow the surgeon to position themselves in their market for what is expected to be the future expansion of this type of payment model into the Commercial payer market and perhaps a mandatory Medicare model.

11. If there are multiple partners in a group, do all partners need to participate?

No as participation is voluntary.   Only one surgeon in the group must be on the enrollment form.  Medicare will provider Target Price data for all physicians in the group however.

12. If one partner has a higher cost, do they have to pay a higher premium, (i.e. their reimbursement is less) or is their higher cost absorbed over the group?

Yes, under the LRP Convener program each EI will ultimately bear the BLISCare costs that reflect their own individual experience.

13. I’m curious how the program with Leavitt Risk will work. Will it basically be a cash pay price that they pay the hospital and anesthesiologist on behalf of the patient?

No, it will work quite a bit differently.   For example, there is no premium payment up front at the time of the case.   All costs come out of the final adjudication several months after the period ends.   Other important differences exist.  Contact LRP at bpcia@leavittrisk.com for details.

14. What is to prevent these surgeons and hospitals from deferring "higher risk patient" and sub-selecting out cases with lower risk and cost to maximize profit?

That potential could exist.   This is one reason why Leavitt Risk is agreeing to cover all of the downside risk for those surgeons who choose to participate with us.    By covering the downside risk, we feel it will allow the bariatric surgeon to ease their way into this type of payment process.    The subsequent experience, reinforced with our data will help them make a well-informed decision on patient selection.