1 Ginger Biesbrock PAC MPH PAC AACC Executive Vice President Care Transformation MedAxiom Disclaimer The Centers for Medicare amp Medicaid Services CMS did not produce or endorse these materials nor does CMS assume responsibility for or make any guarantees of the completeness accur ID: 1042913
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1. BPCI-AdvancedAlternative Quality Measures – Chest Pain MI1Ginger Biesbrock PA-C, MPH, PA-C, AACCExecutive Vice President, Care TransformationMedAxiom
2. Disclaimer: The Centers for Medicare & Medicaid Services (CMS) did not produce or endorse these materials nor does CMS assume responsibility for or make any guarantees of the completeness, accuracy, or reliability of any information contained herein. 2
3. I. Introduction of BPCI-Advanced3
4. Episode includes a specific anchor admission or outpatient procedure (the “trigger event”), and all costs within 90 days of dischargeIn BPCIA, a provider is responsible for managing all aspects of care during a discrete episode.Provider OptionsPGP – Physician Group PracticesACH – Acute Care HospitalsBPCI Advanced: How it worksProviders are given a bundle-specific Target Price to manage an episode of care, e.g. $30k for a PCIProviders keep savings if costs are below the Target Price or may owe money back to CMS if expenditures are higher than the Target Price4Quality measures included which incentivize high quality and penalize low quality
5. Model Year 4 – OptionsBPCI Advanced Quality Measures 5
6. Option 1 - Administrative Quality Measures SetAll-cause Hospital Readmission Measure scored for all bundlesAdvanced Care Plan scored for all bundlesAHRQ Patient Safety Indicators (PSI 90) scored for all bundlesPerioperative Care: Selection of Prophylactic Antibiotic: 1st or 2nd Generation Cephalosporin Hospital-Level Risk-Standardized Complication Rate Following Elective Primary THA/TKAHospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following CABG Excess Days in Acute Care after Hospitalization AMI6
7. Option 2 – Alternative Quality Measures SetNew in 2021Developed with extensive input from - Professional health associationsClinical data registriesClinicians7
8. Select EITHER Administrative or Alternative Quality Measure sets for each clinical episodeParticipants will need to be, or become, members of the relevant registry, or multiple registries, if they select Alternate Quality Measures that are reported by registriesAQMs utilizing registry data will be baselined against 2020A Few Details about Alternative Quality Measures88
9. Quality score is calculated for each individual clinical episodeFor Episode Initiators that participate in multiple clinical episodes, the quality scores for each clinical episode will be combined into a Clinical Quality Score at the EI levelThe Clinical Quality Score at the EI level is weighted by the respective Clinical Episode VolumesThe Clinical Quality Score is converted into a percentage and applied to the Net Total Reconciliation Amount All applicable measures carry equal weightQuality Measure Score Calculation Details9
10. Acute Myocardial Infarction(AMI)10
11. For more informationhttps://innovation.cms.gov/media/document/bpci-advanced-quality-faqshttps://innovation.cms.gov/innovation-models/bpci-advanced/quality-measures-fact-sheetshttps://innovation.cms.gov/innovation-models/bpci-advancedhttps://innovation.cms.gov/media/document/bcpi-model-overview-fact-sheet-my4https://innovation.cms.gov/media/document/bpci-advanced-clinical-episodes-quality-measures-correlation-table-my411