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CMS Announces Bundled Payments for Care Improvement Advanced (BPCI-Advanced) Initiative

Recognizing that bundled payments have been a successful value-based care model, Centers for Medicare & Medicaid Services (CMS) has recently announced the details of its new voluntary bundled payment program, Bundled Payments for Care Improvement Advanced (BPCI-Advanced)

The BPCI-Advanced has multiple qualifications and features worth noting, including:

Eligible Participants:

  • Non-conveners: Acute Care Hospitals (ACH), Physician Group Practices (PGP)
  • Conveners: Participants who bring downstream providers, “episode initiators,” together (ex. may include MSOs, CINs and/ or ACOs)

Specialties primarily impacted:

  • Orthopedics
  • Nephrology
  • Gastroenterology
  • Pulmonology
  • Cardiology

Target Bundle Price:

CMS will use a 3% discount off the “benchmark” price (current FFS rate – see “Data” below).  

Risk/Reward:

The maximum gain and maximum loss per reconciliation period is 20% of the benchmark price. There is also a component based on quality, which can result in a 10% upward or downward adjustment.

Data:

Medical groups are permitted to request from CMS their own historical financial information used to determine the benchmark price (this information may be used ONLY to determine participation).  

Frier Levitt can guide you through the practical, technical, technological and legal aspects associated with participating in the BPCI-Advanced program, including:

  • Obtaining your historical financial data from CMS
  • Reviewing the data to weigh risks/benefits of participation in BPCI-Advanced
  • Applying for participation in BPCI-Advanced
  • Gainsharing agreements for continuum of care partners (learn how profits can be shared with collaborating partners)
  • Risk-share contracting with conveners and/or other third parties

It is important to note that applications must be received by March 12, 2018 to be eligible to participate on October 1, 2018.

If you are interested in taking part in the Bundled Payments for Care Improvement Advanced program or would like additional information, contact Frier Levitt today.