BPCI, CJR AND MACRA—WHAT DO THESE MEAN FOR YOUR HOSPITAL?
You have probably heard these terms thrown around frequently—BPCI, CJR and MACRA—but what are they and how are they causing healthcare transformation and sparking clinical integration in the hospital setting?
Bundled Payment for Care Improvement
- BPCI is comprised of four different models of care by CMS to evaluate effects on costs and patient care1
- Under the initiative, physicians, hospitals and other healthcare organizations enter into payment arrangements that include financial and performance accountability for episodes of care
- Designed to move the healthcare system from volume-based to value-based patient care
Comprehensive Care for Joint Replacement
- CJR is a retrospective bundled payment model for lower extremity joint replacement, and effective April 1, 2016, is mandatory for hospitals in 67 MSAs2
- The CJR model holds hospitals financially responsible for the entire cost of a 90-day episode of care. CMS establishes an episode of care target price that is an incentive for hospitals to work with physicians, home health agencies, skilled nursing facilities and other healthcare providers to ensure beneficiaries receive optimal coordinated care2
Medicare Access & CHIP Reauthorization Act of 2015
- MACRA changes how Medicare beneficiary caregivers are paid, creating a new focus on rewarding physicians for better care rather than more care. MIPS (Merit-based Incentive System) and APM (Alternate Payment Models) are two paths within MACRA.
- MIPS combines and streamlines several government value programs, including the Physician Quality Reporting System and Value-based Payment Modifier, into a single incentive program3
- Measures and rewards physicians on attributes such as Resource Use and Clinical Practice Improvement3
- Currently a proposed rule with target implementation of January 2017