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Providers await drop-out numbers for BPCI Advanced

There's pent-up demand to get into the model but first providers want to see if other participants are staying in.

Susan Morse, Senior Editor

Friday, March 1, was the deadline for providers in the bundled payments for care improvement advanced model to drop-out of the voluntary program.

The Centers for Medicare and Medicaid Services allowed providers to drop-out retroactively, if they found they were not meeting financial targets since starting the program on October 1, 2018.

CMS is expected to release an updated list of BPCI Advanced participants this spring.

Dave Terry, co-founder and CEO of convener Archway Health in Boston, said he expected about 25 percent to a third of his BPCI advanced clients to drop-out. Of the three-quarters staying in the program, about half will drop some bundles, he said.

The company is a convener for a mix of hospital and health systems, cardiology practices, orthopedics and oncology.

One factor that may help is that on Wednesday, CMS came out with a amendments to the BPCI Advanced participation agreement that make the program more attractive, he said.

The change most attractive to providers is the removal of the 50 percent cap on NPRA shared payments and partner distribution payments.

Participants that choose to execute the amendment will be bound by all of its terms and conditions effective on the date it is signed by CMS. Participants that choose not to execute the amendment will not bound by it or receive the benefits, CMS said in an email. The amendment will also be made available at a later time.

"Overall CMS has been good about responding to the market," Terry  said. "They think about modifying the pricing and the use of trend factors."

WHY THIS MATTERS

BPCI Advanced counts as an advanced alternative payment model under MACRA. This is one reason for the robust interest by providers. An estimated 1,299 are in the program.

Meeting targets gives providers the incentive to invest in value-based initiatives.

But once a provider drops out, that incentive is diminished, Terry said.

"We're tracking closely what kind of participation there is," Terry said. "We expect to see a good number drop, especially orthopedic practices. The pricing for those episodes are tight."

The program is designed for providers which have room for improvement. The high-performing practices may decide to get out because there's little room to improve and meet their targets, he said.

"I think people generally like the model, but there's concerns about the pricing and the pace folks need to make decisions," he said.

THE TREND

Providers can 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.

The average number of bundles per provider is about 10, or about 15,000 total bundles in the program, according to Terry, who expects to see less of a drop in cardiology and pulmonology than in orthopedics.

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.

CMS is providing a second application opportunity. The next step will be another open enrollment period in the spring of this year for a January 1, 2020 start date.

Terry believes many providers will decide to get into the program then, but first they want to see how many were successful in the first advanced model, based on the number of dropouts.

"We talked to a lot of providers who thought about getting in but felt they didn't have time. We know there's a lot of pent up demand," Terry said. "I think what happens out of this March 1 drop period, if you see a lot of providers dropping out, it puts negative pressure on these folks unless (CMS) modifies the rules."

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

 

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