Nearly 1,300 entities signed agreements with CMS to participate in the agency’s latest bundled payment initiative, the Bundled Payments for Care Improvement (BPCI) Advanced model.
The model emulates previous BPCI models, with participating entities receiving bundled payments for certain episodes of care instead of traditional fee-for-service reimbursement. BPCI Advanced began on October 1 and will run through Dec. 31, 2023. It was announced in January 2018 and builds off the BPCI, which ended September 30. The model qualifies as an Advanced Alternative Payment Model (APM) under MACRA, providing some reporting requirement exemptions associated with the Merit-based Incentive Payment Systems (MIPS).
“To accelerate the value-based transformation of America’s healthcare system, we must offer a range of new payment models so providers can choose the approach that works best for them,” CMS Administrator Seema Verma said in a statement. “The Bundled Payments for Care Improvement-Advanced model was the Trump Administration’s first Advanced Alternative Payment Model, and today we are proud to announce robust participation. We look forward to launching additional models that will provide an off-ramp to the inefficient fee-for-service system and improve quality and reduce costs for our beneficiaries.”
Participants in BPCI Advanced include 834 acute care hospitals and 715 physician group practices, for a total of 1,547 Medicare providers and suppliers in 49 states plus Washington, D.C., and Puerto Rico. Currently, participants are allowed to retroactively withdraw from the model beginning in March 2019.
BPCI Advanced involves 32 bundled clinical episodes, including 29 inpatient and three outpatient episodes. The outpatient episodes represent the first time these additional episodes have been included in bundled payments. Participants will also receive preliminary target prices––the amount CMS will pay for episodes of care––before the start of each model for planning purposes.
Many major health systems are participating in the new model, including Mayo Clinic, Intermountain, NorthShore University Health System, HCA Health Services, Dignity Health and more.