The new BPCI Advanced bundled payment model means those who invested in the former mandatory bundles didn't throw their money down the drain.
When the Centers for Medicare & Medicaid Services cancelled or scaled back its mandatory bundled payment models last year, many healthcare providers feared the investments they made to prepare for these models might be wasted.
But there's plenty to like about the new voluntary Bundled Payments for Care Improvement (BPCI) Advanced model for organizations that had invested in value-based care models.
In BPCI Advanced, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on seven specific quality measures, says Tobin Lassen, chief knowledge officer with Global Healthcare Alliance in Houston, which has experience helping hospitals, health systems, and physicians manage bundled contracts with both commercial and government payer sources.
The quality measures, the first two of which apply to all clinical episodes (the others are for specific ones) are:
- All-cause hospital readmissions
- Advanced care plan
- Perioperative care: Selection of prophylactic antibiotic: First or second generation Cephalosporin
- Hospital-level risk-standardized complication rate following elective primary total hip arthroplasty and/or Total knee arthroplasty
- Hospital 30-Day, all-cause, risk-standardized mortality rate following coronary artery bypass graft surgery
- Excess days in acute care after hospitalization for acute myocardial infarction
- AHRQ patient safety indicators
Participants bear financial risk, have payments under the model tied to quality performance, and are required to use electronic health record technology that passes CMS certification.
Meeting those requirements qualifies the model as an Advanced APM, which is significant, at least partially, because physicians who participate in one will be exempt from MIPS reporting requirements.
"The 32 types of clinical episodes in BPCI Advanced add outpatient episodes to the inpatient episodes that were offered in the Innovation Center's previous bundled payment model (the Bundled Payments for Care Improvement initiative), including percutaneous coronary intervention, cardiac defibrillator, and back and neck except spinal fusion," according to CMS' website.
Philip Betbeze is the senior leadership editor at HealthLeaders.