October 18, 2018

CMS Announces New Value-Based Bundled Payment Model

On October 9, 2018, the Centers for Medicare & Medicaid Services (CMS) announced its next round of participation in the Bundled Payments for Care Improvement (BPCI) Model, BPCI Advanced. Almost 1,300 entities, including 832 acute care hospitals and 715 physician group practices, have signed agreements to participate.

The BPCI Advanced Model runs from October 1, 2018 through December 31, 2023. It builds on the Bundled Payments for Care Improvement (BPCI) Initiative, which ended on September 30.

BPCI Advanced will initially include 32 bundled clinical episodes. Twenty-nine are inpatient and three are outpatient episodes. Major joint replacement of the lower extremity, congestive heart failure and sepsis are thus far the three most popular bundled clinical episodes selected by participating hospitals and physician groups.

The BPCI Advanced Model is different from the initial BPCI in three key ways:

1) BPCI Advanced qualifies as an Advanced APM. Participating clinicians assume risk for patients’ health care costs and also meet other requirements including meeting quality thresholds that potentially qualify them for incentive payments and exempt them from the MIPS program.

2) BPCI Advanced offers bundled payments for additional clinical episodes, including outpatient episodes. Bundled payments for outpatient episodes were not included in the initial BPCI model.

3) BPCI Advanced provides participants with preliminary target prices before the start of each model year to allow for more effective planning. The target prices are the amount CMS will pay for episodes of care under the model.

See the CMS BPCI Advanced Model webpage for more information.