CMS: BPCI Advanced includes nearly 1,300 providers despite 16% decrease in enrollment

April 15, 2019
Medicare Web

Provider participation in the BPCI Advanced program fell by 16% between October 1, 2018, and March 1, 2019, at the initiation of the risk-bearing phase of the voluntary payment program. Overall participation includes nearly 1,300 providers still participating, according to CMS.

BPCI Advanced is the first advanced alternative payment model introduced by the Trump administration, scheduled to run through December 31, 2023. The model combines payments for physician, hospital, and other provider services into a single bundled payment amount for 29 inpatient and 3 clinical episodes.  

Providers receiving a bundled payment receive a gain or loss in reimbursement for select services based on how successfully they manage resources and costs throughout each episode of care. Providers enrolled in the program did not bear financial risk when BPCI Advanced launched in October 2018 but had to assume risk to continue in the second phase, which began March 1.

Prior to the March 1 deadline, providers could drop out of BPCI Advanced retroactively if they found they were not meeting their financial targets since beginning the program. At the initiation of the risk-bearing phase, the number of providers enrolled in the program dropped by 16%, from 1,547 to 1,295.

The agency anticipates that new amendments to the program will encourage interest in the program for Model Year 3, which begins in January 2020.

One significant amendment CMS made was the removal of the 50% cap on the net payment reconciliation amount shared payments and partner distribution payments. Participants that choose to execute the amendment will be bound by its terms and conditions. Participants that choose not to execute the amendment will not be bound by them, CMS said in an email.

Beginning in April, 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.