Centers for Medicare and Medicaid Services (CMS) continues to implement episode-based metrics for Value Based Payment (VBP) and episode-based payment models as Alternative Payment Models (APMs) in Medicare. However, it is often difficult for providers to assess their episode-based VBP performance results [e.g., Merit-Based Incentive Payment System (MIPS) cost measures, Medicare Spending per Beneficiary (MSPB), etc.] or how to improve upon those results. It is also difficult for providers to determine which voluntary episode-based APMs to participate in, as well as how to succeed in either voluntary or mandatory APMs [e.g., Bundled Payments for Care Improvement (BPCI)-Advanced, Oncology Care Model, etc.]. Dissecting a provider’s underlying data used by CMS to construct the VBP metrics or APM pricing and comparing these to peer-group benchmarks can help providers identify areas for improvement.

Using CMS Innovation Award Data, Dobson|DaVanzo is helping physicians and physician group practices “deep dive” into the complex world of MIPS VBP cost efficiency measures by dissecting risk-adjusted Medicare spending during episodes of care for 18 medical conditions/surgical procedures by clinical theme, type of service, and episode period (pre-, intra-, and post-trigger periods) compared to peer-group benchmarks. This allows providers to easily identify areas for improvement. Our monthly and quarterly data updates provide timely information that allows providers to continually monitor their performance trend overtime.

Our BPCI-Advanced platform replicates the episode construction and target pricing methodology of BPCI-Advanced for 34 clinical episode groups using our Innovation Award data. As CMS explores continuing voluntary programs or mandating Medicare bundled payments, hospitals and physician groups can use these data to: 1) monitor and evaluate how they would perform under a bundled-payment model before going at financial risk; 2) analyze their episodic spending by service type compared to peer-group benchmarks in order to identify areas for improvement; and 3) evaluate performance of downstream providers during the 90-day episode.

CMS has stated that they are strongly committed to implementing episode-based payment models and VBP metrics to test whether linking Medicare provider payments for an episode of care can reduce Medicare expenditures while improving quality of care. With our Innovation Award data and experience with Medicare payment policy, Dobson|DaVanzo is committed to helping provide health care organizations with the data and analytics necessary to succeed in episode-based payment models and VBP. As new episode-based models are introduced by CMS (e.g., Radiation Oncology Payment Model), Dobson|DaVanzo will continue to provide data analytics to assist providers in the mandatory areas prepare for the demonstration.