The very high cost of sepsis to health care is well documented. As illustrated in this article, providers and payors are working diligently to effectively manage costs, while optimizing payments. GE Healthcare will release the results of an economics study later this year to more deeply illuminate cost accounting procedures and the significant costs of sepsis to the hospital operation.
The Centers for Medicare & Medicaid Services' enrollment window for the second wave of bundled payment participants has opened, and new data suggest there's an overlooked area that works well with such a model: sepsis.
Aditya Govil, director of business development at Avant-garde Health, a company that supports providers in these models, told FierceHealthcare that using bundled payments for sepsis is a growing focus at the state level. Current bundles are largely focused in surgical procedures.
“There’s a bigger opportunity for not only hospitals and physicians but also CMS by focusing on sepsis,” he said.
Aditya Govil (Avant-garde Health)
Govil and the team at Avant-garde conducted a review of participation in the first year of the Bundled Payments for Care Improvement Advanced (BPCI-Advanced) model, voluntary bundles which were announced by CMS in January 2018. They provided the report first to FierceHealthcare.
They found that the range of spending CMS will allow for in a sepsis bundle is wide, from just over $15,000 to more than $108,000, and varies based on a number of factors including wage trends in a certain region. However, a bundled payment is effective at keeping the actual costs toward the lower end of the spectrum, at an average of about $34,000 per beneficiary.
Despite the potential financial benefits, sepsis bundles have low market penetration compared to other conditions that can be paid for in an episodic system, according to the report. It ranked fairly low among conditions in BPCI-Advanced for market penetration, with just 480 of nearly 2,900 qualified providers participating in the model at its October launch.
However, even that number of providers includes more than 500,000 patients and could save $15 million in costs.
The number of participants dropped to 316 in March, when CMS pushed BPCI participants into greater risk. Participation decreased overall by about 16% at that time, but experts said the number of providers that remained shows the industry is warming up to the idea of sharing in more financial risk.
Govil echoed that sentiment, saying that the fact that a notable number of providers stayed with a voluntary model that was previously mandatory indicates they’re more comfortable with risk.
“That certainly is the case because the historical precedent is a few other models that dovetail well into this,” he said.
Govil and his team have also penned a guide for providers to use in analyzing which type of bundle they’re best qualified for and which will offer the greatest payoff.
That report identified three key focuses for success in BPCI-Advanced:
Conduct a robust economic analysis. Because bundles are determined by a number of factors, some local and historical, having the data available to clearly show where opportunities lie at an individual basis is crucial.
Consider and track core competencies. Build these into a multiyear plan to allow for a glide path into bundles (and other new payment models).
Be prepared for quality measurement. There are multiple levers to track in BPCI-Advanced, and this can differ between hospitals and other types of providers.
“With such a wide range of target prices, providers would be remiss to not consider the economic opportunity of including BPCI Advanced in their value-based care roadmaps,” the report says.