Bundled Payments for Care Improvement Advanced, CMS' newest bundled payment model, begins Oct. 1.
Here are seven things to know about BPCI Advanced:
1. The bundled payment model, which CMS unveiled in January, includes 32 clinical episodes, with 29 in the inpatient setting and three in the outpatient setting. The clinical episodes may change in the future, as CMS may elect to revise them on an annual basis beginning Jan. 1, 2020.
2. Under the program, provider payments will be based on quality performance during a 90-day episode of care. A clinical episode will begin at the start of an inpatient admission to an acute care hospital, which CMS referred to as the "anchor stay," or at the beginning of an outpatient procedure, the "anchor procedure." The clinical episode will end 90 days after the end of the anchor stay or the anchor procedure.
3. CMS selected seven quality measures for BPCI Advanced. Two of them, the all-cause hospital readmission measure and the advanced care plan measure, will be required for all clinical episodes. The other five measures will only apply to select clinical episodes.
4. BPCI Advanced will qualify as an advanced APM under the Quality Payment Program, meaning participants will be eligible for bonuses under the Medicare Access and CHIP Reauthorization Act.
5. The first cohort of providers will start participation in the model Oct. 1, and the performance period will run through Dec. 31, 2023. Participants may retroactively withdraw all or some episode initiators and/or clinical episodes from the model in March 2019.
6. CMS will provide a second application opportunity for BPCI Advanced in January 2020.
7. BPCI Advanced is distinct from the inaugural BPCI model in several ways, including that BPCI Advanced will require downside financial risk of all participants from the outset. Under the original BPCI model, there was a phase-in period in which participants were sheltered from downside risk.
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