BPCI Advanced Update

CMS clarifies agency policy

On January 30, 2017, the Centers for Medicare and Medicaid Services (CMS) hosted a webinar on the recently released Bundled Payments for Care Improvement Advanced (BPCI Advanced) model. This model will test a new iteration of bundled payments for 32 clinical episodes. BPCI Advanced will also qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program for the 2019 Performance Period.

During the webinar, CMS responded to a variety of questions they received in advance, including the following:

  • Since the Comprehensive Care for Joint Replacement (CJR) model overlaps with one of the BPCI Advanced clinical episodes, major joint replacement of the lower extremity, CMS clarified that clinical episodes triggered under the CJR model for a hospital in a mandatory metropolitan statistical area will take precedence over a BPCI Advanced clinical episode.
  • Application submission does not obligate the submitter to participate in BPCI Advanced. A signed and executed BPCI Advanced model agreement with CMS is required to participate in the model. Participants will be accepted into the BPCI Advanced initiative based on the content of their application and ability to pass multiple levels of program integrity and law enforcement screening.
  • CMS is requesting fraud and abuse waivers for BPCI Advanced. If issued, the waivers will be effective at the start of the model period (October 1, 2018) and available for review by applicants prior to the applicants signing a participation agreement.
  • CMS will be releasing the BPCI Advanced pricing methodology in the next few weeks.

The complete webinar recording and slides are available here.

CMS will be hosting another webinar on BPCI Advanced on February 15 at 12noon ET. Registration information for this upcoming webinar is available here.

Additional information on BPCI Advanced is available here.


For more information visit the McDermottPlus MACRA Resource Center or contact Sheila Madhani at 202-204-1459, smadhani@mcdermottplus.com