With January in full swing, there is now another way to bundle payments. Back on January 9th, the Innovation Center department of the Centers for Medicare & Medicaid Services (CMS) announced that they were instituting a new payment model known as Bundled Payments for Care Improvement Advanced, often shortened to BPCI Advanced. Under this voluntary model, practices now have the option to earn payment based on whether or not all expenses incurred by a patient’s care fall under “a spending target that factors in quality.” This option offers a sharp contrast to the traditional Medicare model in which reimbursement is provided for each individual service.
According to CMS Administrator Seema Verma, this new model will help practices shift toward the new value-based care initiative. “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 Seema in the official CMS press release earlier this month. “Under this model, providers will have an incentive to deliver efficient, high-quality care.”
According to CMS, BPCI Advanced will have six distinct characteristics:
- A single retrospective bundled payment and one risk track, with a 90-day Clinical Episode duration
- 29 Inpatient Clinical Episodes
- 3 Outpatient Clinical Episodes
- Qualifies as an Advanced APM
- Payment is tied to performance on quality measures
- Preliminary Target Prices provided in advance of the first Performance Period of each Model Year
For those participating in the Quality Payment Program, BPCI Advanced will count as an Advanced APM. Any practices wishing to participate will have to act quickly; though the official reporting period ranges from October 1st, 2018 to December 31st, 2023, applications to join the new model must be submitted by March 12th. To submit a completed application, you can visit the CMS BPCI Advanced portal here.