As CMS retools its advanced payment models, providers still grapple with the tech requirements

As providers gear up to participate in CMS’ revamped payment models, one major hurdle stands in the way for many: technology. 

Deirdre Baggot, Ph.D., a healthcare business strategist who has worked with more than 200 hospitals to implement value-based payment models, told FierceHealthcare in an interview that fee-for-service healthcare didn’t really require providers to manage large data sets the way that new advanced payment models do. 

Even as providers invest in better electronic health records and other technological upgrades, plenty of the work and data remains in silos, making it hard to access and use effectively, she said. 

“CMS has released more data in the last 18 months than in the 30 years prior,” she said. “Getting this data into the hands of physicians and understanding how to manage and make more sense of it is probably where I see the biggest gap.” 

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Baggot said that the CEO of a large health system she’s worked with in the past said the system had put more than $1 billion into its electronic health record, but it still couldn’t provide doctors with data that compared spending between them and their peers. 

Bundled payments

In the face of these technological challenges, bundled payments are gaining traction with physicians more quickly than other models since tech requirements are easier, she said. 

The Centers for Medicare & Medicaid Services just closed the application period for its new bundled payment program—Bundled Payments for Care Improvement (BCPI) Advanced—last week and is reviewing potential participants. Despite the challenges that remain in advanced payment models, Baggot said she sees providers growing more willing to jump in and take on risk.

CMS is counting on her prediction being correct. The agency just unveiled an overhaul to the Medicare Shared Savings Program, its most popular accountable care model, aimed at pushing its participants into taking more risk. 

CMS’ new bundled payment model is voluntary, and comes on the heels of the agency’s decision to cancel mandatory versions for cardiac episodes and significantly scale back mandatory bundles for joint replacement surgeries. Critics, including the American Hospital Association, have called for the models to be made voluntary

It will be the first nationwide voluntary bundled payment pilot to include both inpatient and outpatient care and pushes providers to take on downside risk, Baggot said. 

RELATED: Study—Bundled payments drive hospitals to reduce referrals to SNFs, improve coordination 

Though there are challenges, the bundled payment model—which pays out a lump sum for the entire episode of care and thus encourages clinicians to pay greater attention to what treatment options they’re selecting—offers a way for providers to dip their toes into value-based care and is still a very attractive option for them, Baggot said. 

Bundled payments, while they do require digital infrastructures to track spending and improve coordination, have a low entry point and ultimately boil down to an “improvement initiative,” she said. 

“I think bundles are one of those areas where it can be really simple fixes," Baggot said. 

RELATED: Analysis—Mandatory bundled payments have few advantages over voluntary bundles 

The push for value-based care has led to a health system that thinks very differently than it did even five years ago, Baggot said. And while there is still work to be done—especially in getting the tech in place and getting clinicians up to speed—new payment models are beginning to pay off. 

“It’s exciting and fascinating to watch what’s possible,” she said.