Expert Insight into Bundled Payments

Radiation Oncology Proposal Diverges from Prior Bundled Payment Models

radiation therapyLast month, the Centers for Medicare & Medicaid Services (CMS) announced a proposal for a new mandatory radiation oncology (RO) bundled payment model to begin in early 2020. As MedBen Analytics reported after the announcement, the 5-year model would use Medicare data to assess patient outcomes for 17 types of cancer.

Like the current Comprehensive Care for Joint Replacement (CJR) Model, radiation oncology providers would be randomly selected to participate in the RO Model, and payments would be linked to quality metrics rather than fee-for-service. But Health Affairs notes that the RO Model does depart from earlier mandatory bundled payment programs in three distinct ways:

  1. CMS intends to pay RO Model participants on a prospective basis using separate payments for professional and technical components of care.
  2. CMS proposes site neutral payments, using an episode-pricing model that reimburses participants based on hospital-outpatient department rates, irrespective of site of care.
  3. Randomized participation in the CJR Model was limited to selected metropolitan statistical areas, while the proposed RO Model would also select providers from non-rural “micropolitan” areas.

Despite these differences, the CJR and RO Models will share an important attribute: Provider payments will be directly impacted by quality and reporting.

CMS has posted the proposed RO Model rule on the Federal Register. Those who wish to submit a formal comment on the rule may do so until September 16, 2019, at 5 p.m. ET.

As additional information becomes available about the RO Model, we’ll report it in future editions of MedBen Analytics insight. In the meantime, providers with questions about any aspect of bundled payment programs are welcome to contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or


CMS Announces Release of PY3 Reconciliation Payments for CJR Participants

woman joggingThe Centers for Medicare & Medicaid Services (CMS) announced earlier this month that it expected to release Performance Year 3 (PY3) reconciliation payments for Comprehensive Care for Joint Replacement (CJR) participants on July 25 to hospitals that did not submit an appeal.

If your facility earned a PY3 reconciliation payment and MedBen Analytics performs gainshare distribution services for you, we will calculate the distribution based upon the facility’s collaborator agreement. And if MedBen Analytics doesn’t currently perform this service for you, we’ll take this opportunity to remind you that for an additional fee, we can calculate gainshare distribution for your facility as well.

Please note that CJR gainshare distribution takes place just once every 12 months following each performance year reconciliation (i.e., for 2019, based on episodes that ended on or before December 31, 2018). Additionally, if a facility submitted a Calculation Error (CE) Form to CMS to appeal a finding in the PY3 report, gainshare distribution will be delayed until the appeal process has been finalized.

If you have questions about your PY3 reconciliation payment, or are interested in setting up gainshare calculation and distribution services through MedBen Analytics, please contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

CMS Proposes Radiation Oncology Bundled Payment Model for 2020 Rollout

Senior Female Patient In Hospital Bed & DoctorOn July 10, the Centers for Medicare & Medicaid Services (CMS) announced a new radiation oncology model to be introduced in early 2020. The model proposal states that CMS would make bundled payments to cover 90-day episodes of radiotherapy services for 17 types of cancer based on patient diagnoses. Medicare data would be utilized to assess outcomes compared to the current fee-for-services payment arrangement.

Participation in the 5-year model would be mandatory for radiation oncology providers randomly selected from Core Based Statistical Areas (CBSAs). Payments to participants would be linked to quality metrics, including clinical data reporting and patient experience.

According to the proposal, episode payments would be split into a professional component for physician services and a technical component for equipment, supplies, personnel, and other non-physician costs. This division would acknowledge that professional and technical services are sometimes furnished by separate providers or suppliers.

Assuming the radiation oncology model launches as proposed, participants can expect that the MedBen Analytics platform will be ready to furnish actionable reporting that will help them maximize the value of bundled payments. As we receive more specific information about the model, we will make the necessary additions to our software.

MedBen Analytics will provide further information and share observations on the new model as we receive it. In the meantime, if you have any questions or are interested in viewing a demo of our current reporting platform, please contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

MedBen Also Offers Commercial Bundled Payment Services

MedBen BuildingSince 2015, MedBen Analytics has provided bundled payment administration for health systems and hospitals. Now, MedBen third party administration also offers all-inclusive commercial bundled payment services for self-funded employers.

MedBen brings together employers with health care facilities to provide joint replacement services under bundled case agreements. Through these arrangements, employers know exactly what they must pay for a joint replacement procedure, while providers benefit from agreed-upon payments up front and increased steerage to their facilities.

MedBen Analytics reporting extends to employers as well. We provide self-funded businesses with an online executive dashboard that provides measurable and actionable data. Employers can use the reporting platform to spot risks, study trends and identify opportunities for improving care for plan members.

Hospitals and health systems are among MedBen’s largest blocks of self-funded business, so we have a thorough knowledge of their unique qualities as plan administrators as well as caregivers. We welcome any opportunity to work with providers in our capacity as benefits management specialists.

If you’re interested in learning more about commercial services available through MedBen, we invite you to call our Marketing Department at 888-627-8683. Or if you’d like information specifically about MedBen Analytics software for providers participating in Medicare bundled payment models, contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

MedBen Analytics Client Receives 8th Highest NPRA Payment for CJR PY2

A facility using MedBen Analytics‘ reporting insights received the 8th highest Net Payment Reconciliation Amount (NPRA) for plan year 2 (PY2) of the Comprehensive Care for Joint Replacement (CJR) program, according to Initial Reconciliation numbers recently released by the Centers for Medicare & Medicaid Services (CMS). In addition, three MedBen Analytics clients placed in the top 70 for average NPRA per episode.

Of the 721 facilities on the list, 489 had a positive NPRA and received a reconciliation payment. Participating hospitals earned a total of $93.4 million in payments.

MedBen Analytics continues to help clients maximize value from the CJR bundled payment model. We regularly improve our data reporting platform based on client input that enables all participating providers to benefit from their experience.

We invite you to see for yourself what current MedBen Analytic clients already know. To set up a demonstration of our bundled payment software platform, please contact MedBen Manager of Operations Cari Coventry at 800-423-3151, Ext. 405 or email

NOTE: Provider rankings are based upon Initial Reconciliation numbers and may change when CMS releases Final Reconciliation numbers in the coming weeks.

Second Application Period for BPCI Advanced Currently Underway

The application period for the second cohort of participants in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model is currently open and will close on June 24, 2019. The Centers for Medicare & Medicaid Services (CMS) is accepting applications via the BPCI Advanced Application Portal.

The second cohort of participants will start on January 1, 2020, which is Model Year 3. The BPCI Advanced will consist of 37 bundled clinical episodes – 33 inpatient and four outpatient. Model Year 3 will see the introduction of five new episodes, including outpatient Total Knee Arthroplasty (TKA).

CMS has indicated that is not planning any additional application opportunities for BPCI Advanced… so if you’re interested in participating, this may be your final opportunity to apply. And if you have questions about how bundled payments work, we invite you to request a free demonstration of the MedBen Analytics reporting platform.

MedBen Analytics has been delivering bundled payment insights to health systems since 2015. Whether you’re a current BPCI Advanced participant or plan to apply for the second cohort, we can help your organization realize the most value from bundled payments.

Our knowledge of Medicare data consolidation and analysis will provide you with the information necessary to make improvements through the patient journey while unlocking the profit potential of bundled payments. For additional information or to set up a demo, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

You can find additional information about BPCI Advanced and the application process by visiting the CMS Innovation Center.

CJR PY3 Reconciliation Results Available to Clients Soon

The Centers for Medicare and Medicaid Services (CMS) has released the Comprehensive Care for Joint Replacement (CJR) Performance Year 3 (PY3) Initial Reconciliation and PY2 Final Reconciliation Reports. MedBen Analytics has begun the process of auditing the Net Payment Reconciliation Amount (NPRA) for clients, and will soon make reports available via our secure online portal.

A hospital will earn a positive NPRA if the aggregate capped episode cost for PY3 (episodes ending on or before 12/31/2018) is less than the aggregate quality adjusted target price and the composite quality score was Acceptable, Good or Excellent.

As part of our services, we will also notify clients who have a finding in their reconciliation files that may merit further action on their part. If you wish to respond to CMS regarding the findings, you will need to complete and submit the Calculation Error Form (included with the report materials), accompanied by eligibility findings or other relevant information to CMS. Please note that the choice to act on the findings is entirely your decision.

MedBen Analytics clients with questions regarding the findings or submitting calculation error forms are welcome to contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

HHS Making the Move to Mandatory Models

The Department of Health and Human Services (HHS) has indicated that it expects to move away from voluntary value-based payment models. In recent remarks, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said, “Looking forward, you can expect that some of the models we have under development will be mandatory.”

Verma noted that participation in models like BPCI Advanced have been adversely affected by their voluntary nature. “Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate,” she said.

“Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative,” Verma added.

MedBen President & CEO Kurt Harden said that he’s not surprised by Verma’s comments. “CMS had hoped that the transition to value-based care would be further along by now, and shifting the focus to mandatory models will help to speed up the process,” he said. “It will also produce better data and I believe, better procedural and financial outcomes.”

Whether or not we see more mandatory models down the road, MedBen Analytics is ready to help hospitals, health systems and other providers achieve positive results from their participation. 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 Harden at 888-633-2364 or email

Wherever You Work, MedBen Analytics Works for You

Nearly every state currently has or is implementing a value-based model, new research says. MedBen Analytics extends even further than that – our bundled payment reporting platform provides actionable insights to hospitals and health systems nationwide.

Even though MedBen calls Ohio home, our clients can be found as far west as California and in many places in-between. We designed our software to help providers interpret applicable Medicare data so they can maximize the value of bundled payments regardless of location.

With MedBen Analytics, users can quickly access and explore variations in the cost of care at all points in the episode. Real-time reports take just seconds to run and enable you to drill down and find opportunities to uncover inefficiencies and make improvements throughout the patient journey.

Moreover, our propriety software leverages the client experience by expanding report options for all clients based on the request of any client. This approach allows all clients to gain from the experience of other clients.

Whether you’re based in Portland, Oregon or Portland, Maine (or anywhere else), MedBen Analytics will work for your benefit. Learn more by visiting or schedule a demonstration by contacting MedBen President & CEO Kurt Harden at 888-633-2364 or

Joint Replacement Study Finds Bundled Payment Savings

On the heels of a two-year Comprehensive Care for Joint Replacement (CJR) cost analysis comes another study further supporting the cost-saving potential of bundled payments for joint replacement episodes.

According to the Journal of Arthroplasty, researchers studied 319 total hip arthroplasty and bilateral total knee arthroplasty patients, 239 of whom were in a bundled payment program. They found that the bundled payment group had reduced hospital costs ($21,251 vs. $18,783), post-acute care costs ($13,488 vs. $12,439) and overall 90-day episode of care costs ($39,733 vs. $34,305). In total, the bundled payment model saved, on average, $5,811 per patient.

“Our bundled payment program… was successful with reduction in 90-day episode-of-care costs without placing the patient at higher risk of readmission,” the researchers concluded.

Like these two studies, MedBen Analytics has seen first-hand the potential of bundled payments to reduce episode of care costs, for mandatory models like CJR as well as voluntary programs. Of course, when lowering costs it’s vital that quality of care not be sacrificed. That’s why our reporting platform gives providers the information necessary to uncover inefficiencies throughout the patient journey while maximizing value.

MedBen Analytics was created specifically to give providers the insights they need to improve performance. By organizing and interpreting Medicare data, our goal is to ensure your success with bundled payments… in service as well as in savings. If you ever have questions about how we can benefit your business, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email