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CMS launches voluntary bundled payments model, first since spiking mandatory bundles

The agency's Innovation Center said the new Bundled Payments for Care Improvement Advanced model is the first APM that would qualify under MACRA.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Innovation Center has launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced -- which CMS Administrator Seema Verma said is the first Advanced APM. 

The current Bundled Payments for Care Improvement Initiative, or BPCI, is scheduled to end on Sept. 30. BPCI Advanced starts on Oct. 1 and runs through Dec.  31, 2023.

[Also: Voluntary participation in bundled payments will continue after CMS cancels mandatory initiatives, experts say]

The BPCI will qualify as an an advanced alternative payment model under the quality payment program for MACRA. With advanced APMs, providers take financial risk, but can also reap an incentive payment reward.

The model gives incentive payments if all expenditures for an episode of care are under a spending target that factors in quality.

[Also: Transforming bundled payments into episodes of care can give hospitals, payers an edge]

"BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value," Verma said. 

BPCI Advanced participants may receive payment for performance based on 32 different clinical episodes. The clinical episodes in BPCI Advanced add outpatient episodes to the inpatient episodes that were offered in the previous BPCI model, including percutaneous coronary intervention, cardiac defibrillator, and back and neck except spinal fusion.

Last year, the Centers for Medicare and Medicaid Services cancelled or scaled back on mandatory bundled models for joint replacement, hip fractures and cardiac care, but promised to release new voluntary models.

CMS cancelled the episode payment model and the cardiac rehabilitation incentive payment model, which were scheduled to begin on Jan. 1.

The agency also reduced the number of mandatory geographic areas participating in the comprehensive care for joint replacement model, from 67 to 34. Participants in the 33 remaining areas could take part on a voluntary basis.

In BPCI Advanced, 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. Participant bear financial risk, have payments tied to quality performance, and are required to use certified electronic health record technology. 

Like all models tested by CMS, there will be a formal, independent evaluation to assess the quality of care and changes in spending under the model.

Remedy Partners, which works with providers in the current BPCI program, reported in June 2017 that bundles resulted in a $500 million reduction in the cost of unnecessary medical expense over that past year for more than 1,000 providers. In addition, hospital readmissions decreased by 6.1 percent and a patient's length of stay at a skilled nursing facility decreased by 6.3 percent, Remedy said.

Twitter: @SusanJMorse

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