The Centers for Medicare and Medicaid Services (CMS) announced on January 9, 2018 that it is creating the voluntary Bundled Payments for Care Improvement Advanced (BPCI Advanced) demonstration that requires participants to take on financial risk. In addition, the program, which includes outpatient and inpatient episodes of care, would count as an Advanced APM for MACRA (Medicare’s physician payment program) for a 5 percent provider bonus.
Unfortunately, the proposal could have a harmful effect on markets that are affected by the Comprehensive Center for Joint Replacement (CJR) mandate. Those markets may not be able to participate in BPCI Advanced. Click here for full information.
TOA’s April 13-14, 2018 Annual Conference in Fort Worth will include a panel discussion on Medicare’s new bundled payment program.
Medicare-certified acute care hospitals and physician group practices (PGPs) may participate as either Convener Participants or Non-Convener Participants. The application ends on March 12, 2018. The next application period will not occur until January 1, 2020.
Some of the new program’s highlights include:
The CMS Innovation Center will hold a Q&A Open Forum on Tuesday, January 30, 2018 from 11 a.m. – 12 p.m. CST. This event is open to those who are interested in learning more about the model and how to apply. Please register in advance here.
Click here to learn more about the model.
Thirty-two types of clinical episodes will be included. Three outpatient episodes have been added to the inpatient episodes in the earlier BPCI model. Most of the episodes are found in the original BPCI model. However, an episode related to liver disorders is new.
For a list of the 29 Inpatient Clinical Episodes, please see below:
For a list of the 3 Outpatient Clinical Episodes, please see below:
March 12, 2018 – Application portal closes.
May 2018 – CMS distributes target prices.
June 2018 – CMS offers participant agreements.
August 2018 – Signed participant agreements are due.
October 1, 2018 – Model goes live.
March 31, 2019 – First date for Advanced Alternative Payment Model (APM) qualified participant determination.
January 1, 2020 – Next application period.
December 31, 2023 – End of the first cycle.