FutureFocus January 17, 2018: New Voluntary Bundled Payment Model: Impact To Post-Acute Providers

Lisa Remington

In this week's FutureFocus, we address the new voluntary bundled payment model and the impact to post-acute providers. Participants may receive payments on 32 different clinical episodes. Medicare-enrolled or not Medicare enrolled providers or suppliers may participate. We provide the details. In another article, the American Hospital Association comments on MedPAC's proposal for changes to post-acute payments and their concerns with moving this forward. 

Lisa Remington, President, Remington Health Strategy Group

The Centers for Medicare and Medicaid Services (CMS) announced January 9 the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under this bundled payment model, participants can earn additional payment over the usual fee-for-service if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. The goal is to improve quality, coordination, and cost-effectiveness for both inpatient and outpatient care.

 BPCI Advanced participants may receive payments for performance on 32 different clinical episodes—29 in-patient and three out-patient. BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program. “CMS is proud to announce this Administration’s first Advanced APM,” said CMS Administrator Seema Verma. “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. Under this model, providers will have an incentive to deliver efficient, high-quality care.”

BPCI Advanced seeks to support and encourage participants who are interested in:

  • Continuously redesigning and improving care;
  • Decreasing costs by eliminating care that is unnecessary or provides little benefit to patients;
  • Encouraging care coordination and fostering quality improvement;
  • Participating in a payment model that tests extended financial accountability for the outcomes of improved quality and reduced spending;
  • Creating environments that stimulate rapid development of new evidence-based knowledge; and,
  • Increasing the likelihood of better health at lower cost through patient engagement, education, and ongoing communication between healthcare providers and patients.

Key Stakeholders

BPCI Advanced Participants may receive payments for performance on 32 different clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient).

"Other entities that are either Medicare-enrolled or not Medicare-enrolled providers or suppliers may participate as Convener Participants only."

A Convener Participant is a type of Participant that brings together multiple downstream entities, referred to as “Episode Initiators (EIs).” A Convener Participant facilitates coordination among its EIs and bears and apportions financial risk under the Model. A Non-Convener Participant is any Participant that is itself an EI and bears financial risk only for itself.

Entities eligible to be Participants in the Model: Acute Care Hospitals and Physician Group Practices may participate as Convener Participants or Non-Convener Participants. Other entities that are either Medicare-enrolled or not Medicare-enrolled providers or suppliers may participate as Convener Participants only.

Preliminary Target Prices will be provided in advance of the first Performance Period of each Model Year, and will be adjusted during the semi-annual Reconciliation process to calculate a final Target Price that reflects realized patient case mix during the applicable Performance Period.

Key Milestones and Dates:

The Model Performance Period for BPCI Advanced starts on October 1, 2018, and runs through December 31, 2023. Key Milestones: Request for Applications (RFA) released, January 9, 2018; Application portal opens, January 11, 2018; Application portal closes, March 12, 2018 at 11:59 PM EST; Model goes live, October 1, 2018. Next application period start date, January 1, 2020.

The CMS Innovation Center will hold a Q&A Open Forum January 30 from 12 to 1 pm ET. For more information about the model and its requirements or to download a Request for Applications document, the application template, and attachments, visit the BPCI Advanced webpage, clicking here.

The Trump administration’s first Health and Human Services Secretary, Tom Price, pledged to end mandatory bundled payment demonstrations, and HHS/CMS is following through with this voluntary approach.

By: Ronald M. Schwartz, Writer, The Remington Report