Case Study · BPCI Advanced · Orthopedic Episode Management
400-Bed Community Hospital Earns $1.8M in Net BPCI Advanced Savings Across LEJR Episodes
From near-exit to top-quartile performance: how one hospital turned around its bundled payment program in 14 months by fixing the one thing most BPCI participants overlook.
Where they were before: considering exiting BPCI Advanced
This hospital had been a BPCI Advanced participant for two years before engaging SolvEdge. Their Year 2 reconciliation came back with a negative reconciliation amount - they owed money back to CMS. Leadership was frustrated and actively discussing whether to exit the program at the next application cycle.
The CFO brought in SolvEdge for a structured post-reconciliation analysis. What the analysis revealed surprised the team: the hospital was actually performing well on the acute episode (short LOS, low implant variation, good OR efficiency). Their entire reconciliation deficit was coming from the post-acute period. Specifically, two SNF partners were accounting for 61% of their total post-acute spend - and both had 90-day readmission rates nearly double the hospital's other preferred facilities.
"We thought we had a program performance problem. We had a SNF selection problem. Two facilities were costing us the entire reconciliation."
— CFO, Southeast Community Hospital (anonymized)
The 14-month turnaround
Month 1–2: PAC network forensics
SolvEdge pulled episode-level cost data for every SNF that had received a discharge from the hospital over the prior 24 months. Ranked each facility by: readmission rate, average LOS, cost per day, and patient satisfaction scores. The two underperforming facilities were immediately de-emphasized in discharge planning conversations.
Month 3–5: Tiered SNF network construction
SolvEdge facilitated performance conversations with the top 6 SNF partners and built formal preferred-provider agreements tied to readmission rate thresholds and LOS targets. SNFs that met targets received increased referral volume. Those that didn't were moved to Tier 2.
Month 4–8: Real-time episode alerting
Deployed a real-time episode cost dashboard that flagged any episode tracking more than 15% above target within the first 30 days. Care coordinator received an automated alert with the specific cost driver (SNF, readmission, or home health) and a recommended intervention. Average intervention response time: 48 hours.
Month 6–14: Surgeon engagement and implant standardization
Presented surgeon-level episode scorecards at the quarterly orthopedic quality committee. Identified that two surgeons' cases had significantly higher implant costs with no clinical outcome difference. Initiated a structured implant cost review. Average implant cost per LEJR episode dropped 11% over 8 months.
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