Expert Insight into Bundled Payments

Next BPCI Advanced Application Period Begins Spring 2019

If you didn’t apply to participate in the Bundled Payments for Care Improvement Advanced (BPCI) Advanced model earlier this year but are still interested in doing so, you don’t have too long to wait. The next application period for BPCI Advanced is scheduled to begin in Spring 2019, with the second cohort starting on January 1, 2020.

The first round of BPCI Advanced applications saw nearly 1,300 providers sign on to participate, including 832 acute care hospitals and 715 physician group practices. The new model runs from October 1, 2018 through December 31, 2023.

For those who participated in (or are familiar with) the original BPCI initiative, the new program offers additional features and incentives, such as:

  • BPCI Advanced qualifies as an Advanced Alternative Payment Model (APM) under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Quality Payment Program. Because participants take on additional financial risk, they can earn a five percent bonus.
  • The Advanced model offers participants three outpatient care episodes – Percutaneous Coronary Intervention, Cardiac Defibrillator, and Back & Neck except Spinal Fusion. Meanwhile, inpatient episodes have been reduced to 29 (from the original 48), to better focus on those episodes that have demonstrated the greatest provider interest and potential for return.

The Centers for Medicare & Medicaid Services (CMS) will release additional details about the next application period soon. In the meantime, as with all bundled payment models, MedBen Analytics supports BPCI Advanced participants with actionable insights that turns data into decisions and profit potential. If you have any questions or are interested in viewing a demo of our current reporting platform, please contact Harden at 888-633-2364 or email

First CMS Report on CJR Model Finds Reduced Care Costs

The recently-released first annual report from the Centers for Medicare & Medicaid Services (CMS) on the progress of the Comprehensive Care for Joint Replacement (CJR) model suggests that the bundled payment approach is having the desired result of maintaining quality care while lowering costs and improving patient outcomes.

Based on 2016 information from participating hospitals in the 67 metropolitan statistical areas (MSAs) included in the model, average total payments for CJR episodes decreased by 3.3% compared with control group episodes. MSAs with historically high and low episode payments saw CJR payment reductions of $1,127 and $577, respectively.

A portion of the cost decrease derived from a shift in the post-acute care setting. The report cited a decrease in the use of an inpatient rehabilitation facility (IRF) directly following an elective episode, and a corresponding rise in home health agency use.

The report also found a statistically significant relative reduction in the average number of days CJR patients spent in an institutional post-acute care setting. However, the changes to post-acute settings and durations did not affect the quality of care provided.

In working with CJR participants, MedBen Analytics has seen first hand how bundled payment data can help to make improvements in the delivery of care. Timely and relevant information allows administrators, clinicians, and strategists to compare individual hospital performance (or a hospital system’s performance) to the regional performance. From there, a data-driven dialogue can begin.

Communication based on actionable insights enables internal review of procedures and resources. Clinical and financial goals can then be set and measured, while also reporting and monitoring claims-based quality measures.

We invite you to see for yourself how MedBen Analytics can turn data into informed decisions. To set up a demonstration, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

CJR Takes Precedence to Original BPCI Participants

Questions have arisen as to how the end of the original Bundled Payments for Care Improvement (BPCI) initiative affects participants that also happen to be located in a mandatory Metropolitan Statistical Area (MSA) for the Comprehensive Care for Joint Replacement model (CJR), as well as precedence regarding CJR and the new BPCI Advanced model. The Centers for Medicare & Medicaid Services (CMS) recently provided guidance for participating hospitals on these matters.

  • According to CMS, clinical episodes in the BPCI initiative continued to have precedence over CJR clinical episodes until September 30, 2018, the final day of the initiative. Hospitals participating in the BPCI initiative that are located in a mandatory MSA became CJR participant hospitals as of October 1, 2018.
  • Hospitals located in a mandatory MSA are not eligible to participate in BPCI Advanced for CJR episodes. However, they may participate in BPCI Advanced for non-CJR episodes.
  • Under BPCI Advanced, the order of precedence will reverse and all CJR episodes (in either mandatory or voluntary MSAs) will have precedence over BPCI Advanced lower extremity joint replacement episodes.

Participating hospitals with questions regarding these changes or other issues can e-mail

The MedBen Analytics reporting platform has provided actionable insights to both BPCI and CJR participants since 2015. If your hospital participated in the BPCI initiative and has questions about the transition to the CJR model, or if you are interested in viewing a demo of our current reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

Voluntary vs. Mandatory: What’s the Future of Bundled Payment Participation?

On October 1, the Centers for Medicare & Medicaid Services (CMS) will roll out its newest bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced). This voluntary program builds on the foundation of the original BPCI initiative, which began in 2013 and will end on September 30.

The commitment to further testing the potential of BPCI might suggest that CMS believes that the future of value-based payments is in voluntary participation. Factor in the 2017 cancellation of several mandatory bundled payment initiatives, coupled with a reduction in the number of health systems participating in the Comprehensive Care for Joint Replacement (CJR) model, and it’s easy to conclude that moving forward, voluntary programs will become the norm.

However, the confirmation of Alex Azar as Health and Human Services (HHS) Secretary this past January reopened the possibility that, in spite of the earlier actions, mandatory models may still be a viable option… and indeed, recent comments by Azar indicate we’ll see additional mandatory programs down the road.

“We need strategies and models that provide better care at a lower price, not just new models for the sake of new models and not new systems of payment for old systems that aren’t open to real change,” Azar said at a meeting of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) earlier this month. “In some cases that’s going to mean mandatory models from CMMI [Center for Medicare & Medicaid Innovation] and other mandatory reforms.”

As for what models will be subject to mandatory participation, CMS Administrator Seema Verma says the focus will be on high-cost conditions. “We’re looking at end-stage renal disease, cancer care, chronic disease, [and] individuals with serious medical conditions,” she said at the PTAC meeting.

But regardless of whatever future direction bundled payment models take, MedBen Analytics is ready to help hospitals, health systems and other providers achieve positive results from their participation. We work with both voluntary and mandatory models, and the insights offered through our innovative reporting software platform will enable your organization to ensure the highest level of care while unlocking profit potential.

If you’d like to see a demonstration of our system or want additional information about MedBen Analytics, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email

MedBen Analytics Helps Hospitals to Better Coordinate Discharges

A new study published in JAMA highlights positive discharge numbers for hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model.

The study analyzed changes in discharges to institutional post-acute care after lower extremity joint replacement (LEJR) episodes among Medicare beneficiaries following implementation of the CJR bundled payments in 2016. Comparing metropolitan statistical areas (MSAs) covered by the CJR to a group of control MSAs, the study found patient discharges to institutional post-acute care was 30.8% for CJR participants… 2.9% lower than the control group. The study authors called this “a significant difference,” though they cautioned that further evaluation was necessary.

Improving the coordination of discharge patterns and enhancing the utilization of post-acute services can increase the quality of care delivered to the patient. MedBen Analytics provides the reporting necessary to compare current performance to benchmarks which allows clinical and strategic decision support teams to set goals and measure performance over time.

The insights offered through timely analytic information can decrease claim costs and increase internal cost savings. All of the lessons learned that are a result of bundled payments spill over to the overall population, thereby benefitting patient and provider alike.

MedBen Analytics is designed with the express purpose of maximizing the value of care provided to patients by decreasing ineffective costly treatment while helping providers to ensure the best patient care. We’d be happy to show you how our reporting platform can work to your best advantage. To set up a demonstration, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email

MedBen Analytics’ Data Usefulness Goes Beyond Reports

MedBen Analytics turns Medicare claims data into actionable reports, enabling you to find opportunities that impact your business. However, the usefulness of our bundled software platform doesn’t stop there.

When MedBen Analytics receives your data, our proprietary software first organizes it before producing the reports that help you interpret the data. But in addition to our reporting features, the arranged data is available as downloadable spreadsheets that can be used to merge with other medical data you have gathered for further analysis.

For instance, some hospitals participating in value-based care programs are working to reduce their use of disabling medications, in order to decrease patient side affects, lower length of stays, and reduce costs. Moreover, the ongoing opioid epidemic has led to a concerted effort to lessen the use of addictive medications and supplement them with safer alternatives. But such actions must be measured against satisfactory patient outcomes… and data processed through MedBen Analytics can be used in tandem with data from the medical records for this purpose.

Via the portal, a provider can generate a coordinated spreadsheet with length of stay and cost data, and then merge it with their own medical record data. This information can be reviewed together to analyze the safety and cost-effectiveness of reduced disabling medicine use.

Of course, this is just one example of how the usefulness of the MedBen Analytics platform can extend beyond report generation and interpretation. Learn more about how you the ways you can benefit from bundled payment data insights by contacting MedBen President and CEO Kurt Harden at 888-633-2364 or

CMS Releases Corrected PY1, PY2 Reconciliation Reports

Last week, The Centers for Medicare & Medicaid Services (CMS) released corrected Performance Year (PY) 1 final reconciliation reports and PY2 initial reconciliation reports. This action was taken after an error was detected in the application of exclusion logic for Bundled Payments for Care Improvement (BPCI) episodes during the 2018 Comprehensive Care for Joint Replacement (CJR) reconciliation processing.

While CMS believes that this error has not materially impacted every hospital’s PY1 final and PY2 initial reconciliation reports, the PY1 final reconciliation reports issued on both June 5, 2018 and June 29, 2018 and the PY2 initial reconciliation reports issued on both June 5, 2018 and June 29, 2018 have been withdrawn. Accordingly, all appeals received regarding these reconciliation reports have been dismissed.

The corrected reconciliation reports and related data files were posted to the CJR electronic funds transfer (EFT) accounts last week. Hospitals have 45 calendar days from date posted in the EFT account to appeal the new reconciliation reports. MedBen has retrieved the new files for our clients and will upload them in the MedBen Analytics Portal on Friday, August 3.

In light of these corrected reconciliation reports, clients who utilize MedBen Analytics’ CJR gainshare distribution services will receive a revised list of claim billing errors that could impact a physician’s eligibility to gainshare, or reduce the dollar amount they are able to receive. If you do not have these services, MedBen can administer the allocation of profits resulting from high-quality, cost-effective care between the hospital and its collaborators for a nominal fee.

Clients with questions regarding the PY1 and PY2 report changes are welcome to contact Cari L. Coventry, Manager of Operations for MedBen Analytics, at If you’re interested in setting up gainshare calculation and distribution services or to learn more about them, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

CMS Announces Important Changes to BPCI Advanced

Two recent announcements by the Centers for Medicare & Medicaid Services (CMS) has altered the implementation and operation of the Bundled Payments for Care Improvement (BPCI) Advanced model:

  • CMS extended the deadline for returning the BPCI Advanced signed participation agreements and clinical episode selections to August 8, and the due date for program deliverables to Sept. 14 – both dates one week later than the original deadlines. The agency released a revised model timeline reflecting these changes.
  • CMS also announced that BPCI Advanced participants will be able to retroactively withdraw beginning in March 2019. The move serves as a compromise to the American Hospital Association and other industry groups, which had requested that the agency add additional start dates in 2019.

The changes were likely made due to delays in the transmission of target prices and data to applicants, originally scheduled for May but not delivered until June. CMS said it is still planning to announce participants this September, and has maintained that program will still launch on October 1 as previously scheduled.

Even with the additional seven days to return signed participation agreements and clinical episode selections, the window to formally participate in BPCI Advanced is quickly closing. But if you still have questions about the model or bundled payment programs in general, MedBen has the answers.

The MedBen Analytics reporting platform has been delivering bundled payment insights to health systems participating in CMS Bundled Payment Care Initiatives since 2015. Among our clients are Top 30 and Top 100 earners from the Comprehensive Care for Joint Replacement Program. We have managed bundled payment analytics for both retrospective and prospective BPCI participants.

MedBen Analytics is ready to help your organization make a smooth transition to bundled payments. For additional information or to set up a demonstration of our reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

MedBen Analytics Helps Client Detect Costly Care

A MedBen Analytics client discovered that when it comes to data analysis, it pays to compare… literally.

The client, a hospital system frustrated with its results from another data service, switched to MedBen Analytics. This client found immediate results, expanding the number of people with access to their data just by using our proprietary software. And the ability to drill down into reports and find opportunities to improve service has a demonstrable impact on the client’s bottom line.

A review of post-acute cost and stay lengths brought out a disturbing trend in skilled nursing use – it appeared that patients were consistently assigned to lengthy and costly skilled nursing stays. Using the average cost and stay data, the system and its physicians revised their discharge process to ensure patient received the most appropriate post-acute care.
The result? Happier patients, shorter stays, and hundreds of thousands of dollars in savings for the health system.

MedBen Analytics is more that just a reporting portal… our platform is designed to help your business evolve with the changes in health care payments by feeding relevant and timely payment data to your decision makers. We make it easier to uncover inefficiencies and make improvements throughout the patient journey.

MedBen Analytics invites you to compare for yourself. To set up a demonstration of our reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

BPCI vs. CJR: Participation and Performance

Using Medicare and American Hospital Association data, Health Affairs recently compared characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs.

Findings from their analysis include (per Becker’s Hospital Review):

  • BPCI hospitals generally were larger than CJR hospitals, and had higher average Medicare patient volume (nearly 7,200 compared to about 5,300).
  • BPCI hospitals were more likely to be nonprofit, teaching hospitals and sole community providers compared to CJR hospitals.
  • Both BPCI and CJR hospitals were similar as far as baseline readmission rates and mortality rates.
  • BPCI hospitals had greater cost from institutional post-acute care, primarily due to inpatient rehabilitation facility cost, but researchers note the differences are not large.

The study’s authors concluded: “These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.”

MedBen Analytics is used by BPCI and CJR participants alike, and based on CMS results and client feedback, both groups have realized success with our reporting portal. Our goal is to make sure that all providers, regardless of why they participate, can benefit from the bundled payment model.

We developed MedBen Analytics to give providers the insights they need to improve performance – and we earn and keep clients by proving that bundled payments save them time and money over traditional fee-for-service. If you ever have questions about how our services can benefit your business, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email