CMS signs up 1,547 providers for new bundled payment model

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The Centers for Medicare and Medicaid Services has announced that 832 acute care hospitals and 715 physician group practices are participating in a new value-based bundled payment model.

The 1,547 participants in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) can qualify as an Advanced Alternative Payment Model (Advanced APM) under the agency’s Quality Payment Program and are exempted from the reporting requirements associated with the Merit-Based Incentive Payment System.

“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,” said CMS Administrator Seema Verma in a written statement. “The BPCI Advanced model was the Trump administration’s first Advanced APM, and we are proud to announce robust participation. 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.”

Under Advanced APMs, providers bear financial risk, have payments tied to quality performance, and are required to use Certified Electronic Health Record Technology. The first cohort of participants in BPCI Advanced started on Oct. 1, 2018, and the model performance period will run through Dec. 31, 2023.

“As of the Participant’s start date in BPCI Advanced (Oct. 1, 2018), the Participant must use Certified Electronic Health Record Technology (CEHRT) to document and communicate clinical care to their patients or other healthcare providers,” according to CMS.

A participant is defined by the agency as an entity that enters into a participation agreement with CMS to participate in the model—1,299 entities have signed agreements with the agency to participate in BPCI Advanced.

“For hospitals that are Non-Convener Participants, the hospital must use CEHRT,” adds the agency. “For Physician Group Practices (PGPs) that are Non-Convener Participants, at least 50 percent of the PGP’s eligible clinicians must use CEHRT. For Convener Participants who will have hospitals and PGPs as Episode Initiators, the hospitals must use CEHRT and at least 50 percent of the eligible clinicians in each PGP must use CEHRT.”

A Convener Participant is a type of participant that brings together multiple downstream entities, referred to as Episode Initiators (EIs), and facilitates coordination among its EIs as well as bears and apportions financial risk under the model. A Non-Convener Participant is a participant that is in itself an EI and does not bear risk on behalf of multiple downstream EIs.

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

Participants in the BPCI Advanced model will receive payments for performance on 32 different clinical episodes—29 inpatient and three outpatient. The top three clinical episodes in which providers selected to participate were major joint replacement of the lower extremity, congestive heart failure, and sepsis.

According to CMS, participants in BPCI Advanced starting on October 1 had to “commit to be held accountable for one or more Clinical Episodes and may not add or drop such Clinical Episodes until Jan. 1, 2020.” At that time, the agency said it “may elect to revise the Clinical Episodes in BPCI Advanced on an annual basis.”

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