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What to Know About CMS's New Bundled Payment Model

By Susan Eymann, MS13 Jun 2018

CMS announced a new voluntarily bundled-payment model, called the Bundled Payments for Care Improvement-Advanced Model (BPCI Advanced), that is considered the first alternative model proposed by the Trump administration. 

bundled-payment-modelThis comes after CMS decided to cancel two bundled-payment models created by the Obama administration, including the Comprehensive Care for Joint Replacement Model. Cardiac payment models were also canceled, despite hospitals that advocated for voluntary participation as they had already invested resources to launch the models. Here’s what participants need to know about the new voluntary bundled-payment models:

  1. The new model includes 32 clinical episodes such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient). Twenty-nine of these are in the inpatient setting and three in the outpatient setting. Participants must select at least one of the 32 clinical episodes to apply to the model.
  2. There are seven quality measures for BPCI Advanced. The all-cause hospital readmission measure and the advanced care plan measure will be needed for all clinical episodes. The other five measures will only apply to select clinical episodes.
  3. Clinician payment will be based on quality performance during a 90-day episode of care.
  4. BPCI Advanced will qualify as an advanced alternative payment model (APM), allowing participants to be eligible for bonuses under Medicare Access and CHIP Reauthorization Act (MACRA).
  5. Under BPCI Advanced, participants will be expected to maintain or improve the quality of care while keeping within Medicare expenditure within budget.
  6. CMS states that participants should join if they are interested in continuously redesigning and improving care, decreasing unnecessary medical costs, improving care coordination, and participating in a program that links financial accountability to improved quality.
  7. Participation in this model will require participation in a formal, independent evaluation to assess the quality of care and changes in spending, as with all models tested by CMS.
The Model Performance Period for BPCI Advanced starts on October 1, 2018 and runs through December 31, 2023. Providers have until March 12 to apply. CMS will provide a second application opportunity for BPCI Advanced in January 2020. More information about the model and its requirements, along with a request for an application can be found here.

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