How To Succeed With BPCI

by | May 25, 2022 | Blog | 0 comments

BPCI (Bundled Payments for Care Improvement) is a value-based care initiative created by the Centers for Medicare and Medicaid (CMS) to help to improve the efficiency and efficacy of a patient’s care without sacrificing the quality of care. BPCI is an agreement that a team of physicians and other healthcare professionals make with the CMS in which they work together to streamline the patient care process and reduce costs.

How Does BPCI Work?

With BPCI, if a patient needs a specific course of treatment, let’s say knee replacement surgery, for example, the cost of everything required to complete the treatment is covered in one preset payment. For the knee replacement surgery, this would include presurgical visits and testing, the surgery, hospitalization, rehab, and any follow-up visits.

This payment is made to a single doctor, let’s say the surgeon, who takes on the responsibility of making sure that all of the remaining medical professionals who work to get the patient to a full recovery receive their share of the payment. The hope is that this format will foster greater communication between those providing the different aspects of the treatment plan and avoid repetitive or unnecessary steps along the way.

Perhaps the biggest incentive to keep costs down is the fact that, at the end of the treatment program, after all providers have been paid, if there is any money left in the original payment, the surgeon who received that payment may keep the balance. On the flip side, if the treatment program goes over the expected amount, it’s the surgeon’s responsibility to cover the costs out of their own pocket.

How Is BPCI Different for the Patient Than Traditional Model of Health Care?

Throughout the entire process, from diagnosis to surgery to complete rehabilitation, the patient should not notice any change in the quality of care they receive. The main difference they will notice is that now every aspect of the treatment plan is organized and set up by the staff at the surgeon’s office.

With BPCI, patients are no longer responsible for finding their own rehab centers, visiting nurses, or other health care professionals related to their knee replacement surgery. There is also no need for patients to keep track of their health records or prescriptions, as all of this information will be provided to the entire treatment team from the surgeon’s office.
In most cases, the whole experience runs more smoothly for patients involved in BPCI programs.

Why Are Some Doctors Hesitant to Use BPCI?

To take advantage of the benefits provided by the BPCI initiative, doctors must work out of a fully upgraded office. Both they and their staff must be fluent in the software needed to input, store, and disseminate patient information quickly and efficiently.

Without the use of this software, and the technology used to work with it, it would be next to impossible for the medical office to keep all of the details of multiple patients’ treatment programs straight. That doesn’t even include the need to communicate with all of the other health care providers involved in the treatment plan. If a doctor has not taken the steps to modernize and digitalize their practice, then BPCI is really not an option for them.

Other doctors may be hesitant to make use of BPCI because they fear they will get stuck covering bills for unexpected setbacks or for treatments that require more time and visits than anticipated. While these things could happen, the use of care pathways and clinically integrated networks drastically reduces the chance of unexpected cost of care.

Care Pathways

Care pathways can be thought of as road maps for clinical care. These guidelines clearly lay out treatment plans for specific health issues, including the recommended treatments, steps of the treatment plan, and expected length and cost of treatment. There are even contingencies plans built into most care pathways to help predict likely setbacks and problems. This allows CMS to set a bundled payment that allows for the possibility of these events occurring.

The hope is that by standardizing treatment plans for common ailments and injuries, costs can be kept down and successful results can be brought up.

Clinically Integrated Networks (CINs)

The use of electronic health records has allowed for the development of clinically integrated networks. These networks connect all of the various healthcare providers needed to successfully treat a patient, from start to finish. For the knee surgery recipient, the CIN would include all of the labs, the surgeon and his team, the hospital and their team of nurses and practitioners, the physical therapists, visiting nurses, and any other person directly involved in the patient’s recovery.

A clinically integrated network allows one office to coordinate the care of a patient from diagnosis to full recovery. This streamlines the entire process and leads to a higher quality of care, usually at a lower cost.

Finding Success With BPCI

As with many things in life, the key to success with BPCI is finding the right partner. In this case, you will need a partner that can provide you with a reliable platform from which all of your network connections can be built.

TRIARQ is just such a partner. Their QPathways cloud software provides a combination of financial and clinical reporting tools, data management, and instant communication, and connects all concerned healthcare providers to a single network. Once connected, all team members have access to the same information, medical records, treatment plans, medications given, and procedures scheduled and finished, in real-time.

QPathways also includes the patients in the network connections. This makes it possible for any member of the treatment plan team to communicate directly with the patient if desired. The patient connection can help avoid delays and confusion, both of which may raise the cost of care.

QPathways makes use of the standardized care pathways to make scheduling and timely communication a breeze. All the medical office has to do is enter the diagnosis and the applicable pathway will walk them through all of the necessary treatment steps, from pre-op testing to complete recovery.

TRIARQ is a management services organization devoted to helping doctors and other healthcare practitioners navigate the digital aspects of health care. TRIARQ clients reap the benefits of clinically integrated networks and other cloud-based solutions to help keep the practice of medicine running smoothly and efficiently.