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Unsure about Bundled Payments for Care Improvement model? Apply now so you can decide later

Hospitals that apply by March 12 can wait for further target pricing information and make up their minds in August whether to participate in BPCI.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Services is reporting high interest in the new Bundled Payments for Care Improvement Advanced model that appears to be moving forward despite a request by the American Hospital Association to delay implementation citing a lack of operational detail, especially over target pricing.

CMS has held two information sessions on BPCI Advanced, the last one on Feb. 15. After the last session, CMS said it has received a high volume of inquiries on the model.

[Also: Providers pleased at most of what's in new voluntary bundled payment model]

Target pricing is expected in May.

"We have very strong interest in the advanced program," said Chris Garcia, CEO of Remedy Partners that acts as convener for about 700 companies in the current BPCI. There's another 300 or 400 providers that have shown interest in participating in the new program, he added.

[Also: CMS launches voluntary bundled payments model, first since spiking mandatory bundles]

Whether or not the providers move forward to participate in BPCI Advanced, depends on that pricing methodology. 

"The devil's in the details," Garcia said. "It will make or break how the details roll out. On the surface, the program is easy to understand."

In a February 12 letter, the AHA requested that the application deadline for BPCI Advanced be delayed from March 12 to April 16. But during the Feb. 15 webinar, CMS took questions about a delay, and gave no indication this would happen.

The application deadline remains March 12. 

Whether a hospital or physician group is interested in applying, or  unsure, apply anyway, said Keely Macmillan of Archway Health.

Applying doesn't commit a provider to taking part. A definite decision does not have to be made until August for implementation of BPCI Advanced on October 1, said Macmillan, general manager of BPCI at Archway, which is also a  convener on behalf of providers. 

"We've been emphasizing to people, you don't have to decide now if you're participating," Macmillan said. "Just keep your options open."

There's much to like in this updated, voluntary bundled payment initiative, as it qualifies as an advanced alternative payment model and its 5 percent bonus under MACRA.

Unlike the current BPCI, the new model is open to specialists.

"It certainly is a selling point," Garcia said. "Specialists have limited opportunities to participate in an advanced APM."

A disadvantage is that it eliminates post acute care providers from owning the bundle. They must go through a hospital. 

BPCI Advanced is more sophisticated, and the pricing more accurate and complicated, said Macmillan, who added she sees favorable factors in pricing.

CMS will first provide a preliminary target and then a final price after the performance period is over, to risk adjust for the patient population, Macmillan said. If the population is sicker than originally thought, CMS will adjust the pricing. This risk adjustment helps to prevent any incentive to cherry-pick patients.

"We see this as a positive development," Macmillan said.

CMS has also clarified that internal cost savings can be used in gain sharing. CMS will be creating waivers for physicians to share in the savings. 

In this updated version of the BPCI, CMS has listened to provider concerns and is taking into account regional spending differences. 

CMS is applying a regression model to a peer-adjusted trend factor, which will account for the size of a hospital, and whether it's in an urban or rural location. 

"They're doing away with the national trend factor and replacing it with a peer adjustment factor," Macmillan said. "They have to take historical data and trend it forward."

There's 29 inpatient and 3 outpatient clinical episodes in BPCI Advanced.

Bundles save money, both experts said.

"Hospitals want to participate," Garcia said. "They understand this is way CMS pays in the future. Hospitals are continuously trying to improve their relationship with physicians. Hospitals can say, if you participate, we can help you meet thresholds."

Twitter: @SusanJMorse
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