New voluntary bundled payment model announced by CMS

Seema Verma, MPH

Later this year, providers wanting to take advantage of the 5 percent bonus for participating in an Advanced Alternative Payment Model (AAPM) can join the new Bundled Payments For Care Improvement-Advanced Model (BPCI-A) launched by CMS on Jan. 9.

BPCI-A is voluntary bundle which will offer payments for performance on 32 clinical episodes such as major lower extremity joint replacement, percutaneous coronary intervention, cardiac defibrillator, and back and neck except spinal fusion. Twenty-nine of the included episodes are located in inpatient settings and three are in outpatient settings.

“BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” CMS Administrator Seema Verma, MPH, said in a statement. “Under this model, providers will have an incentive to deliver efficient, high-quality care.”

The model is the first AAPM announced under the Trump administration’s leadership at CMS. It’s also the first announced since the agency cancelled two mandatory bundled payments and promised to develop more voluntary payment experiments.

Coincidentally, the announcement came on the same day Trump’s nominee for HHS Secretary, Alex Azar, told members of Congress he supports mandatory payment models.

BPCI-A participants will be paid based on quality performance during a 90-day episode of care. Being a bundled payment model, there is financial risk involved for providers. The model would offer clinicians another avenue to enter the AAPM track of the Quality Payment Program set up by the Medicare Access and CHIP Reauthorization Act (MACRA), avoiding the Merit-based Incentive Payment System (MIPS) and becoming eligible for the 5 percent AAPM bonus.

Interested providers have until March 12 to apply for the model, with the first cohort beginning Oct. 1. The program will continue through 2023.