A total of 832 acute care hospitals and 715 physician group practices are participating in Medicare’s Bundled Payments for Care Improvement – Advanced model, the Centers for Medicare & Medicaid Services announced today. The advanced Alternative Payment Model began Oct. 1 and will run through 2023. It builds on the BPCI initiative that ended last month to include an initial 29 inpatient and three outpatient episodes of care. Participants assume risk for patients’ health care costs and can qualify for incentive payments and exemption from reporting requirements under Medicare’s Quality Payment Program for clinicians if they meet certain quality and other requirements. The top three episodes in which providers chose to participate were major joint replacement of the lower extremity, congestive heart failure and sepsis.
AHA has urged CMS to offer two additional start date options for the model in 2019. CMS had planned to release data on episode target prices and summary and raw claims data to applicants in May, but many had not received it by late June, leaving fewer than two months to analyze the data before the Aug. 1 deadline to sign participation agreements.
Also today, CMS released a 2013-2016 evaluation report and summary for BPCI Models 2-4. Model 2 episodes began with a hospital admission and extended for up to 90 days; Model 3 episodes began with post-acute care following a hospital admission and extended for up to 90 days; and Model 4 episodes began with a hospital admission and continued for 30 days. According to the report, most participants have been in Models 2 and 3, which both maintained quality of care while reducing Medicare fee-for-service payments for the majority of clinical episodes before accounting for reconciliation payments.