More than 250 providers have dropped out of BPCI Advanced, but despite the 16 percent drop in numbers, the Centers for Medicare and Medicaid Services and two conveners interviewed still call participation in the bundled payment model robust.
CMS on Thursday announced 715 acute care hospitals and 580 physician group practices remain in the bundled payments for care improvement advanced program, for a total of 1,295 Medicare providers.
This is a loss of 252 providers from the 832 acute care hospitals and 715 physician group practices, a total of 1,547, which began the program in October.
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A total of 1,086 contracts, that can cover numerous providers, remain as participants for the BPCI Advanced model for year 2. In October 2018, that number was 1,299.
"My take is that I'm not surprised, participants were aware of this withdrawal opportunity," said Gina Bruno, vice president clinical strategy, naviHealth. Most providers "saw this as participation at scale. I think knowing that they had that get-out-of-jail free card led some to be more ambitious in participation. I'm also not surprised so many have remained."
Archway Health expected to see some providers drop-out completely and also to drop-out of certain bundles, said Keely Macmillan, general manager of BPCI Advanced for Archway. About 35 percent dropped out of the bundled model for major joint replacement of the lower extremity. This was due to CMS's change in payment, taking total knee replacement off the inpatient only list and reimbursing as outpatient surgery. Hospitals volume dropped so much it didn't make sense to participate in program, she said.
WHY THIS MATTERS
March 1 was the deadline for providers in the bundled payments for care improvement advanced model to drop-out of the voluntary program if they found they weren't meeting financial targets.
One factor that may have helped keep providers in the program, is that just before the March 1 deadline, CMS came out with an amendments to the BPCI Advanced participation agreement to make the program more attractive, including removing the 50 percent cap on the net payment reconciliation amount, or NPRA shared payments and partner distribution payments. This imposed cap had limited the earnings of physician groups.
Also, BPCI Advanced qualifies as an advanced alternative payment model under MACRA, so participating providers can be exempted from the reporting requirements of the the merit-based incentive payment system (MIPS) and qualify for incentive payments.
However, being an Advanced APM was not the predominant factor cited by providers for getting into or staying in the model, Bruno said. Most providers "saw this as participation at scale, as an opportunity to make change," she said.
This matters as CMS has said it plans to roll-out mandatory bundled models in the future.
BPCI Advanced was a great way for providers to ease into value-based care, Macmillan said. Participants get claims data and that type of insight allows providers to take more ownership in the care continuum.
"They get data they wouldn't otherwise have," Keely said.
CMS said it intends to open the application period for Model 3 in April, and that there will be no more enrollment periods for model years 4 or 5.
There's a lot of interest in participating, according to Bruno.
"They've been watching over two quarters, so they're prepared to apply," she said.
The BPCI Advanced Model was announced in January and runs from October 1 through December 31, 2023. CMS set a deadline of August 8, 2018, for organizations to decide whether to participate in the bundled payment model. But providers were given the opportunity to reassess their decision in March.
Providers could choose from 32 clinical episodes, including 29 inpatient and three, outpatient. Payments are based on performance during a 90-day episode of care that continues after discharge or the outpatient procedure.
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