CMS to begin accepting applications for BPCI Advanced, Model Year 3
CMS announced that it will soon begin accepting applications to participate in its second cohort of the Bundled Payments for Care Improvement (BPCI) Advanced Model starting in January 2020.
The federal agency recently announced via email that it intends to open the application period for the program’s third performance year sometime in April. Launched in October 2018, BPCI Advanced is the first advanced alternative payment model introduced by the Trump administration, scheduled to run through December 31, 2023.
The voluntary model combines payments for physician, hospital, and other provider services into a single bundled payment amount. Under this model, CMS currently offers bundled payments for 32 clinical episodes—29 inpatient and three outpatient. The agency is finalizing the selection of new clinical episodes for Model Year 3, which will include outpatient total knee arthroplasty.
According to a CMS press release, hospitals and providers participating in BPCI Advanced receive a single, retrospective payment for each 90-day clinical episode. A participant can earn additional reimbursement if all expenditures for a beneficiary’s episode of care are less than a spending target, which factors in measures of quality. Conversely, if the expenditures exceed the predetermined target price, the participant must repay money to Medicare.
CMS categorizes hospitals and providers enrolled in BPCI Advanced into two groups: Convener Participants and Non-Convener Participants. A Convener Participant brings together multiple entities referred to as “Episode Initiators”—which must be either acute care hospitals (ACHs) or physician group practices (PGP)—to participate in BPCI Advanced, bearing financial risk on their behalf. A Non-Convener Participant is any participant that is not a Convener Participant, that bears financial risk only for itself.
As noted on the CMS website, organizations interested in applying to participate as a Non-Convener Participant must be an ACH or a PGP. A Convener Participant may be a non-Medicare provider or supplier, a post-acute care provider, an accountable care organization, ACH, or PGP.
Eligible hospitals and providers interested in applying for Year 3 of the BPCI Advanced Model may submit an application via the BPCI Advanced Application Portal.
More information on the BPCI Advanced Model can be found in this CMS fact sheet and on the CMS website.