CMS unveils new, voluntary bundled payments program
Shortly after announcing that it has eliminated several existing bundled payment initiatives, CMS has announced a new bundled payment model that focuses on voluntary participation. Dubbed “Bundled Payments for Care Improvement Advanced” (BPCI Advanced), the new program is based on the older BPCI program that it replaces.
CMS had previously cancelled its Episode Payment Models (EPM) program and scaled back procedure-specific programs such as the Comprehensive Care for Joint Replacement (CJR) model, but agency officials said the moves did not mean CMS was abandoning bundled payments. Instead, under the Trump administration, CMS wants such programs to be run on a more voluntary basis, as reported in the last issue of The Business of Medicine.
BPCI Advanced is just such a model: Participation is voluntary and the performance period begins on Oct. 1, 2018, running through Dec. 31, 2023. The deadline to apply for participation is March 12, 2018.
Below are a list of highlights for BPCI Advanced with an emphasis on its impact to practices:
- Acute care hospitals and physician group practices may participate as Conveners or Non-conveners. Much like in the original BPCI program, conveners are the episode initiators, responsible assuming financial risk episode costs and for organizing downstream entities to coordinate resource use and reduce costs. Non-conveners are all the other entities that participate but assume financial risk for themselves only.
- Qualifies as an Advanced Alternative Payment Model (A-APM). CMS has already declared BPCI Advanced to meet its criteria for an A-APM, which means participating groups will be exempt from participating in the Merit-based Incentive Payment System (MIPS) while earning flat 5% positive Medicare payment adjustments. Note: This will begin with the 2019 MIPS performance year.
- All participants bear downside financial risk. Unlike the original BPCI program, BPCI requires immediate assumption of downside financial risk by all participating entities at the start of the performance period. The payment model is otherwise similar to BPCI, with fee-for-service payments made normally before being reconciled retrospectively against a pre-determined target cost for each type of clinical episode.
- Inpatient episodes for multiple specialties. Inpatient episodes for BPCI Advanced span multiple specialties and include double joint replacement procedures for the lower extremity, acute myocardial infarction, cardiac arrhythmia, cellulitis, bronchitis and asthma, coronary artery bypass graft, femur, hip, and pelvic fractures, gastrointestinal obstruction, major bowel procedures, renal failure, sepsis, stroke, and urinary tract infections.
- Outpatient clinical episodes for multiple specialties. These include percutaneous coronary intervention, cardiac defibrillators, and back & neck procedures except spinal fusion.
Applying for BPCI Advanced
CMS has already launched its online application portal for BPCI Advanced which you can visit at https://app1.innovation.cms.gov/bpciadvancedapp. You have until March 12 to apply and CMS is expected to announce selected applicants beginning May 2018.