BPCI Update: CMS Posts Details on Model Years 1 and 2

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:

  • BPCI participants – January 2019 (updated 1/23/19)

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 Episode Initiators and Clinical Episode Selections – January 2019 (updated 1/23/19)

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.

  • Quality Measure Correlation to Clinical Episodes – Model Years 1 & 2 (updated January 2019)

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.


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