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BPCI Advanced model attracts 'robust' interest of almost 1,300 providers

The top three clinical episodes selected are major joint replacement of the lower extremity, congestive heart failure, and sepsis.

Susan Morse, Senior Editor

Close to 1,300 provider entities have signed on to participate in the bundled payments for care improvement advanced model, the Centers for Medicare and Medicaid Services announced today. 

The 1,299 organizations include Adventist Health System, Advocate Health System, Dignity, Geisinger, Mayo Clinic, Memorial Hermann, Mercy Health, Prime Healthcare and Trinity.

When broken down by individual Medicare providers and suppliers, 1,547 are participating in the voluntary program, including 832 acute care hospitals and 715 physician group practices.

BPCI Advanced includes 32 bundled clinical episodes, of which 29 are inpatient and three, outpatient. The top three clinical episodes selected by participants are major joint replacement of the lower extremity, congestive heart failure, and sepsis.

BPCI Advanced replaces the BPCI Initiative that, as of July 1, had 1,025 participants, including 255 acute care hospitals, 485 skilled nursing facilities, 192 physician group practices, 43 home health agencies, and nine inpatient rehabilitation facilities.

Conveners interviewed before today's release said they expected more interest in the program this time around, motivated in part by the model qualifying as an advanced alternative payment model under MACRA. Participating providers can be exempted from the reporting requirements associated with the merit-based incentive payment system.

WHY THIS MATTERS

BPCI Advanced providers have signed agreements with the Centers for Medicare and Medicaid Services to receive bundled payments for certain episodes of care as an alternative to fee-for-service in which Medicare pays for each individual service.

Under this value-based agreement of BPCI Advanced, participants take on risk, a direction CMS supports, as evidenced in its recent overhaul of the Medicare Shared Savings Program.

BPCI Advanced participants can earn an additional payment if all expenditures for a beneficiary's episode of care are less than a spending target. But if the expenditures exceed the target price, the participant must repay money to Medicare.

BPCI Advanced provides participants with preliminary target prices before the start of each model year to allow for more effective planning. The target prices are the amount CMS will pay for episodes of care under the model.

THE TREND

The BPCI Advanced Model was announced in January and runs from October 1 through December 31, 2023. The BPCI Initiative ended on September 30. 

The original BPCI Initiative had encouraging results, CMS said.

ON THE RECORD

"The bundled payments for care improvement – advanced model was the Trump Administration's first advanced alternative payment model, and today we are proud to announce robust participation," said CMS Administrator Seema Verma. "We look forward to launching additional models that will provide an off-ramp to the inefficient fee-for-service system and improve quality and reduce costs for our beneficiaries."

"After seeing the success with BPCI Classic, we knew that BPCI Advanced would attract more providers this time; the list confirmed that. The unique participant number is at about 1,300, but that includes multi-campus hospitals and systems. The real number is over 1,500. What we're really glad to see is that BPCI Advanced participants weren't afraid to try the new bundle additions – participation in the three new outpatient procedures includes totals to more than half of the participants. And, a significant amount of participants opted for the only new inpatient bundle (disorders of the liver) as well," said Keely Macmillan, general manager of BPCI Advanced for Archway Health.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

 

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