New CMS Bundled Payment Model Recruits 1,300 Providers

The five-year program involves 832 acute care hospitals and 715 group practices representing 1,547 Medicare providers and suppliers in 49 states.

Nearly 1,300 providers have signed on to participate in Medicare's newest at-risk bundled payment initiative, the Centers for Medicare & Medicaid Services announced Tuesday.

The BPCI Advanced Model was unveiled in January and runs from October 1, 2018 through December 31, 2023, building on the Bundled Payments for Care Improvement Initiative (BPCI) that ended September 30.

The participants in the five-year program include 832 acute care hospitals and 715 physician group practices representing 1,547 Medicare providers and suppliers in 49 states and the District of Columbia, CMS said.

Under the new payment model, providers are at risk for financial losses if they can't contain patient care costs within a spending range set by Medicare. They keep a share of what they save on costs, as long as quality metrics are met.  

BPCI Advanced will include 32 bundled clinical episodes—29 inpatient and three outpatient. The top three clinical episodes are major lower joint replacement, congestive heart failure, and sepsis. 

"To accelerate the value-based transformation of America's healthcare system, we must offer a range of new payment models so providers can choose the approach that works best for them," CMS Administrator Seema Verma said in a media release.

"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," Verma said.

"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," she said.  

The BPCI program qualifies as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization ACT, which means that providers in the model will be exempted from reporting requirements under the Merit-based Incentive Payment System.

After hearing complaints from providers, CMS said it will issue preliminary target prices before each model year of BPCI Advanced to allow for planning.

At a conference in Washington, D.C., this week, American Hospital Association CMO Jay Bhatt, DO, said hospitals' success in bundled payment models requires access to timely data for evidence-based decisions on changes to care delivery, and cooperation across care settings.

"We especially need payers to routinely provide timely—if not real-time—data in a readily usable format to hospitals and others participating in bundled payment models so that these participants can make evidence-based decisions on changes to care delivery," Bhatt said.

Bhatt said stakeholders should also communicate about what works, and what doesn't, reduce regulatory burdens, balance risk and reward, and integrate accountability for quality and financial incentives across care venues and payer models.

Clarification: The wording of this story has been updated to clarify that participants share a portion of the money they save, if they meet quality goals.