How Can a Bariatric Surgeon Enroll?
To participate in BPCI-A, you must be listed on an application that is due into CMS on or before June 24, 2019. Leavitt Risk Partners is applying as a Convener Participant. All U.S. bariatric surgeons performing any of the three DRGs included by CMS, are invited to become Episode Initiators (EIs). All EIs under Leavitt Risk Partners providers will be fully protected from all downside risk imposed by CMS under the program. EIs will also be able to participate financially in the potential upside.
Surgeons or Physician Groups can enroll by providing their information via the link below. There is NO obligation on the part of the provider to participate in the program by submitting their information to Leavitt Risk Partners. The submission will authorize CMS to provide the surgeons historical data and target prices to Leavitt Risk to evaluate and provide to the surgeon. Only at a later date in November, 2019, will the provider decide to sign a participation agreement for the year 2020.
What is BPCI-A?
The Bundled Payment for Care Improvement – Advanced initiative within CMS is a voluntary value-based payment arrangement between providers and CMS. The bariatric bundles are retrospective 90-day bundles that are evaluated after the fact. Providers who are enrolled receive a target price for their bundle. Enrolled providers bill CMS and are payed at the normal fee-for-service Medicare rates. After the bundle is complete, the actual costs of the episode are evaluated against the target price. If the average actual cost per episode is lower than the target price, CMS compensates the provider with the difference. If the opposite occurs, the provider pays CMS the difference. For more detailed information, see https://innovation.cms.gov/initiatives/bpci-advanced
Why Should Bariatric Surgeons Participate in BPCI-A?
1. Bariatric surgeons already manage the episode – With bariatric surgery, the surgeon is the quarterback of care in the 90-day episode. This specialty has already created centers of excellence to deliver positive outcomes. Bariatric surgeons have greater control on the outcome of the episode than in many other specialties.
2. Financial upside – The performance in bariatric surgery continues to generate a higher number of positive outcomes year-over-year. The BPCI-A program will compensate for those improvements in care yielding greater financial reward.
3. Value-Based Care is coming – The BPCI-A program is currently a voluntary program to enlist providers to generate greater quality at a lower price. This trend is occurring both in commercial and government industry. How long is participation going to remain voluntary?