New Version of Bundled Payments Will Have Broader Appeal

Gregory A. Freeman, December 4, 2017

CMS may appear to be slowing the path to value-based care by ditching some bundled payment models, but a new program could revitalize the effort. The new initiative will draw in more physicians who were not attracted to the earlier versions.

The CMS decision to eliminate two mandatory bundled-payment models and reduce participation in a third should not be taken as a sign that value-based care has lost momentum. To the contrary, the upcoming Bundled Payments for Care Improvement (BPCI) Initiative will actually speed up this shift and be a catalyst to end the fee-for-service model altogether, one analyst says.

CMS recently finalized plans to cancel mandatory hip fracture and cardiac bundled payment models, as well as the Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model that were due to go into effect on January 1, 2018. The rule also reduces the geographic areas required to participate in the Comprehensive Care for Joint Replacement Model from 67 to 34.

CMS also published its third annual evaluation of BPCI Models 2 to 4, which found that during the first two years of the BPCI model, Medicare payments for major joint replacement of the lower extremity fell $1,273. However, there were few statistically significant quality changes during the first two years of the BPCI initiative under Model 2.

These moves raise questions about whether the shift to value-based payments will continue at the pace of recent years, but the imminent release of the next incarnation of BPCI should increase momentum, says Keely Macmillan, general manager of BPCI with Archway Health, which assists healthcare providers with bundled payments.

The original BPCI program will end in September 2018 and CMS is expected to announce plans for the next phase any day now, she notes.

“The BPCI Advanced program will be a major catalyst for the adoption of value-based payments because it will bring so many new participants to the market,” Macmillan says. “There is a lot of pent up demand because at first physicians weren’t ready for BCPI and now it’s been several years. There is a better understanding of the program and a recognition of the outside revenue that can be earned.”

Gregory A. Freeman

Gregory A. Freeman is a contributing writer.

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