February 05, 2019
The Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) recently posted a number of documents related to the Bundled Payments for Care Improvement Advanced Model (BPCI Advanced). The model, which launched in October 2018, will test a new iteration of bundled payments for 32 Clinical Episodes and aim to align incentives among participating health care providers for reducing expenditures and improving quality of care for Medicare beneficiaries. BPCI Advanced will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.
Recently posted documents include:
For purposes of BPCI Advanced, a Participant is defined as an entity that enters into a Participation Agreement with CMS to participate in the Model. BPCI Advanced will require downside financial risk of all Participants from the outset of the Model Performance Period.
BPCI Advanced will initially include 29 inpatient Clinical Episodes and three outpatient Clinical Episodes. Based on rapid-cycle feedback and experience to date in the initiative, CMS may elect to revise the Clinical Episodes in BPCI Advanced on an annual basis beginning January 1, 2020, which will apply to both new Participants and existing Participants. Participants selected to participate in BPCI Advanced beginning on October 1, 2018, must commit to being held accountable for one or more Clinical Episodes and may not add or drop such Clinical Episodes until January 1, 2020.
CMS has selected seven quality measures for the BPCI Advanced Model – Years 1 and 2 (2018 and 2019). Three of them, All-cause Hospital Readmission Measure, Advance Care Plan and the CMS Patient Safety Indicators will be required for all Clinical Episodes. The other four quality measures will only apply to select Clinical Episodes.