CMS launches new voluntary bundled payment model

BPCI Advanced is aimed at aligning payment and care incentives, putting new pressure on providers to implement IT that supports value-based care.

The Centers for Medicare and Medicaid Services on Tuesday announced a new voluntary bundled payment model that will qualify as an Advanced Alternative Payment Model under the agency’s Quality Payment Program.

The QPP has two tracks: the Merit-Based Incentive Payment System (MIPS) and Advanced APMs. Under Advanced APMs, providers take on financial risk to earn the incentive payment.

The CMS announcement continues the move to value-based care, furthering the shift to information technologies that better manage care, risk, and cost. To be successful in the Advanced APM environment, healthcare providers will need access to comprehensive claims and clinical data and infrastructure investments in electronic health records, data analytics, and population health tools.

The effort is an outgrowth of the Bundled Payments for Care Improvement initiative, developed by the Center for Medicare and Medicaid Innovation, created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid or Children’s Health Insurance Program expenditures while preserving or enhancing the quality of care for beneficiaries.

“BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” said CMS Administrator Seema Verma in a written statement. “Under this model, providers will have an incentive to deliver efficient, high-quality care.”

Participants in the new Bundled Payments for Care Improvement Advanced (BPCI Advanced) will receive payments for performance on 32 different clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient).

“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 specific quality measures,” states the CMS announcement. “Participants bear financial risk, have payments under the model tied to quality performance and are required to use Certified Electronic Health Record Technology. By meeting these requirements, the model qualifies as an Advanced APM.”

Also See: How bundled payments will challenge providers’ IT systems

The first cohort of participants in BPCI Advanced will start Oct. 1, 2018, and the model performance period will run through Dec. 31, 2023. CMS said it will provide a second application opportunity in January 2020.

“Like all models tested by CMS, there will be a formal independent evaluation to assess the quality of care and changes in spending under the model,” according to the agency.

Additional information about BPCI Advanced and its requirements can be found here, as well as the ability to download a request for applications document, the application template and the necessary attachments. Those interested in applying have until March 12.

To learn more about the bundled payment model and how to apply, the CMS Innovation Center will hold an open forum on January 30 from 12 to 1 p.m. EDT. Registration is required here.

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