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CMS Launches New Voluntary Bundled-payment Model

January 10, 2018

The Center for Medicare and Medicaid Innovation, part of The Centers for Medicare & Medicaid Services (CMS), announced the first advanced alternative payment model under the Trump administration.

The new, voluntary bundled payment model, called Bundled Payments for Care Improvement Advanced (BPCI Advanced), is slated to begin October 1, 2018, and run through December 31, 2023. There are 32 types of clinical episodes (29 inpatient and three outpatient) included in the model.

Rather than paying providers for each service they perform, bundled payment models are built on the premise of providing one single payment for an overall episode of care. The model is intended to motivate providers to provide efficient, high quality, coordinated care.

BPCI Advanced requires participating providers to accept downside financial risk from the outset of the performance period. Both acute care hospitals and physician group practices are eligible to become convener participants or episode initiators. Payment will be tied to performance on a select number of quality measures including the All-cause Hospital Readmission Measure and Advance Care Planning Measure.

BPCI Advanced will also meet criteria to qualify as an Advanced Alternative Payment Model—an important component of the Quality Payment Program, which was recently implemented under the Medicare Access and CHIP Reauthorization Act, to pay clinicians for their services.

CMS is holding an Open Door Forum on January 30, 2018, at 12 p.m. to answer questions on the model.  Applications to participate in the model must be submitted via the BPCI Advanced Application Portal by March 12, 2018.  

HAP has been supportive of CMS’ effort to move towards a value-based reimbursement system. This voluntary bundled initiative is another step towards this goal. 

Questions can also be directed to BPCIAdvanced@cms.hhs.gov.  For additional information, contact Kate Slatt, HAP’s senior director, health care finance policy.

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