CMS’ innovation center launches BPCI Advanced voluntary payment model

CMS announced January 9 the launch of Bundled Payments for Care Improvement Advanced (BPCI Advanced) from the agency’s Center for Medicare and Medicaid Innovation (CMMI). This is the first Advanced Alternative Payment Model introduced by the Trump administration.

BPCI Advanced is intended to further the shift from fee-for-service to quality-based payments for providers. It is a voluntary model that allows participants to receive additional payment for clinical episode if the cost of the care is below a targeted amount, a change from the mandatory CMMI models CMS cancelled last year.

BPCI Advanced includes 32 clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient). Of those 32 episodes of care, 29 are inpatient and three are outpatient. The clinical episodes are expected to be revised annually beginning in January 2020. By comparison, CMS’ previous Bundled Payments for Care Improvement initiative included only inpatient clinical episodes.

BPCI Advanced participants will be responsible for maintaining or improving performance based on a set of seven quality measures, two of which are required for all clinical episodes included in the program and five of which will only apply to select clinical episodes. The required measures include all-cause hospital readmissions and advance care plans.

Participants must use Certified Electronic Health Record Technology as part of the program. Target prices for care will be provided prior to the first performance period of each model year.

The BPCI Advanced performance period is October 1, 2018, through December 31, 2023. Applications for participation in the first round of the program are due March 12, through CMS’ Application Portal. The following round of applications, as well as the next time providers will be able to add or drop clinical episodes, is not expected until January 2020.

For additional information, including a complete list of quality measures and clinical episodes, visit the CMS Innovation Center.