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The Centers for Medicare & Medicaid Services (CMS) designed the Bundled Payments for Care Improvement (BPCI) Advanced Model to fundamentally bend the cost curve for a given episode of care, ensure greater coordination across providers and healthcare settings, and provide Medicare patients with higher-quality care. Health systems that choose to participate can benefit from aligning incentives across their hospitals, physicians and post-acute care providers.
When implemented successfully, bundled payment models are saving money and improving care at the same time. And nearly 1,300 entities are participating in the BPCI Advanced Model because they know the program is a strategic opportunity to receive positive financial rewards for success.
The BPCI Advanced Model can be a great choice to help health systems achieve future success in a value-based care delivery environment. Let’s break down the five things to know ahead of the application deadline.
Participants selected to participate in the program through the upcoming application period will begin during the third model year, which starts on Jan. 1, 2020, and ends Dec. 31, 2023.
Application timeline:
Additionally, the time period for Model Year 3 baseline data is Oct. 1, 2014, to Sept. 30, 2018. However, due to data restrictions, applicants and participants will only be eligible to receive three years of baseline data. Therefore, applicants, pending submission of a Data Request and Attestation, and participants will receive baseline claims data in raw and/or summary formats, from Oct. 1, 2015, to Sept. 30, 2018.
Other details of the program include:
CMS has added the following additional clinical episode bundle options for Model Year 3, increasing the total number of potential episode initiating clinical episodes to 37 (33 inpatient, four outpatient).
Participants may be given the option to select from either the current claims-based "Administrative Quality Measures" set or an "Alternate Quality Measures" set that would include a combination of claims-based and registry-based measures.
CMS will release additional information on the Alternate Quality Measure set prior to the close of the application period. The established Composite Quality Score calculation methodology will apply to both. All participants, regardless of the set choice, will be accountable for no more than five measures per clinical episode.
CMS is considering whether to modify BPCI Advanced to incentivize the use of cardiac rehabilitation and intensive cardiac rehabilitation services for BPCI Advanced cardiac clinical episodes. The purpose is to increase utilization of cardiac rehabilitation and intensive cardiac rehabilitation services for BPCI Advanced beneficiaries.
Research has demonstrated improved long-term cardiovascular outcomes for patients who participate in cardiac rehabilitation therapy. CMS has indicated that they intend to provide further information regarding the cardiac rehabilitation incentive prior to the end of the application period (June 24, 2019).
The model allows two types of participants:
Current participants can add new Episode Initiators to their participation without going through the application process via the Episode Initiators Addition Template. Convener participants that would like to restructure by separating their downstream Episode Initiators into multiple agreements can submit an Episode Initiators Restructuring Template. Current applicants wishing to make modifications to provider Episode Initiators within their agreement must submit requested changes through the BPCI Advanced Participant Portal.
Participating in the BPCI Advanced model can help health systems stay ahead of the shift to risk-based payment models, as well as increase revenue, manage margins and get better reimbursement. However, providers must have an essential skill set in order to engage in and prepare for these models. BPCI Advanced participation requires expertise, foresight, claims analytics capabilities and planning to develop an effective approach as well as implement gainsharing arrangements with physicians.
Premier® offers a range of expertise in bundled payment model readiness, preparation, development and implementation, including for BPCI Advanced. For more information on the second cohort of BPCI Advanced Model Year 3, watch our webinar.