Stay Vigilant: The Government Shutdown Didn't Shut Down Insider Trading Enforcement – Shutting down the United States federal government in late 2018 and early 2019 created the unfortunate perception that government watchdogs might not be able to catch up with illegal behavior, like insider trading. The government reopened in February, though, and the Securities and Exchange Commission’s Division of Enforcement continues to actively investigate potential wrongdoing. Political frustration, safety risks, economic impact, and especially the personal toll on families of federal workers and other businesses aside, the longest government shutdown in history did not stop government enforcement. And for corporate officers, directors, employees, or service providers who do not intend to violate the law, nothing has changed regarding their need to protect confidential company information from disclosure to those who don’t need to hear it. For more information, see the King & Spalding Special Matters and Government Investigations Client Alert, available here.
CMS Announces Second Enrollment Period for BPCI Advanced – CMS intends to release its second enrollment period for the Bundled Payment for Care Improvement (BPCI) Advanced payment model sometime in April 2019, allowing for eligible providers to participate beginning January 1, 2020 through December 31, 2023. Those interested in applying, or who have been waiting for the right opportunity to apply, will have one last chance to apply for the BPCI Advanced model sometime in April 2019. CMS indicates that this is the last opportunity to enroll in BPCI Advanced. Therefore, now is the time to gauge interests from strategic partners to determine if participating in BPCI Advanced is the right payment model opportunity for you.
BPCI Advanced is one of many payment models from the CMS Center for Medicaid and Medicaid Innovation (CMMI). CMMI tests various payment and service delivery models to help reduce expenditures while improving the quality of care. CMMI’s BPCI Advanced payment model is a voluntary initiative that takes a retrospective bundled payment approach. BPCI Advanced will provide a single bundled payment to various healthcare providers for items and services furnished during an episode of care. However, that bundled payment is determined retrospectively. In other words, healthcare providers continue to receive fee-for-service (FFS) payments, but at the end of a performance year, CMS compares the amounts of FFS payments to a target price. Depending on whether the total FFS payments for an episode of care exceeds or falls short of the target price, healthcare providers will either share in the savings with CMS or owe a repayment amount. Notably, all participants in BPCI Advanced must take on downside risk.
Currently, BPCI Advanced contains 29 inpatient clinical episodes and 3 outpatient clinical episodes. Along with the second enrollment period for BPCI Advanced, however, CMS plans to finalize new bundles for the remaining performance years, which will include outpatient total knee arthroplasty. Aside from the foregoing, CMS did not release further information about other potential changes to the BPCI Advanced payment model in advance of the second enrollment period. Additionally, the second enrollment period coincides with a drop off in participation in BPCI Advanced. CMS provided a March 1, 2019 deadline for providers to withdraw from participation in BPCI Advanced without facing any financial risk. Of the approximately 1,500 providers who initially participated in the model, 1,295 currently remain, comprising 715 acute care hospitals and 580 physician groups. Although BPCI Advanced experienced a modest drop off in participation, healthcare providers can expect participation to increase as part of the second enrollment period.
At this juncture, providers should evaluate whether applying to participate in BPCI Advanced aligns with their long-term strategic goals. BPCI Advanced provides healthcare providers an opportunity to execute various alignment strategies, particularly among hospitals, physician group practices, and post-acute care providers. Additionally, eligible providers participating in BPCI Advanced to a sufficient degree could receive a 5% lump-sum incentive payment under the Advanced APM track of the Quality Payment Program. With CMS signaling that the second enrollment period in April 2019 as the last opportunity to enroll in BPCI Advanced, healthcare providers should monitor CMS’s website for BPCI Advanced to find out when the request for application is announced. Last year’s request for application is available here.