CMS announces new voluntary bundled payment model

January 17, 2018
Area(s) of Interest: MACRA Payor Contracting Payor Issues and Reimbursement Practice Management 

The Centers for Medicare and Medicaid Services (CMS) has announced a new voluntary bundled-payment model. Called the Bundled Payments for Care Improvement (BPCI) Advanced Model, it will be considered an advanced alternative payment model (APM) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

This new, voluntary model comes less than two months after the CMS eliminated two mandatory bundled-payment models created during the Obama administration.

MACRA’s Quality Payment Program (QPP) created two tracks for physician payment – the Merit-Based Incentive Payment System (MIPS) and Advanced APM track.  Under MIPS, providers report a range of performance metrics and their payment amounts are adjusted based on their performance.  Under Advanced APMs, providers take on financial risk to earn Advanced APM incentive payments.

The new BPCI-Advanced model will include 32 clinical-care episodes to choose from, 29 inpatient and three outpatient. Participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget, while maintaining or improving performance on specific quality measures.  Participants can earn payment bonuses if all expenditures for a beneficiary’s episode of care are under a spending target.

The performance period for BPCI Advanced starts on October 1, 2018, and runs through December 31, 2023. Applications for the initial enrollment period are due by March 12, 2018, at 8:59 p.m. P.T.

Click here for more information about the BPCI-Advanced model and its requirements

The CMS Innovation Center is also holding an open forum for those interested in learning more about the model and how to apply. The one-hour call will be on Tuesday, January 30, 2018, from 9 to 10 a.m. P.T. Advanced registration is required.


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