This year is monumental for CMS' Bundled Payments for Care Improvement initiative, especially for hospitals and health systems that have taken on the most advanced bundled payment model.
Within BPCI, there are four models. Model 4 focuses on the inpatient stay, and hospitals will assume responsibility for all related readmissions. Hospitals can select which diagnosis-related groups they want to be included in the bundled payments, such as pacemaker insertion, cervical spinal fusion, congestive heart failure, sepsis, major hip/knee replacements and several others.
What separates Model 4 from the other models, however, is how providers are paid. In the other three, providers are paid retrospectively, meaning they receive fee-for-service payment, but later there is a retrospective comparison with a previously determined target price. In Model 4, hospitals agree to an upfront price on the specific DRGs, and CMS pays that specific bundled price to the hospital, which then pays other physicians and caretakers. In essence, Model 4 is the epitome of what bundled payments are to be in the future.
Hospitals in Model 4 are currently in "Phase 1," also known as the preparation period to assume financial risk. Phase 1 will end this fall, and soon thereafter, Phase 2 (the risk-bearing period) will begin. Here are the 62 hospitals participating in BPCI's Model 4, according to CMS' latest data. Many are within large health systems, including Dallas-based Tenet Healthcare Corp. and San Francisco-based Dignity Health.
• Arrowhead Hospital (Glendale, Ariz.)
• Bronson Methodist Hospital (Kalamazoo, Mich.)
• California Hospital Medical Center (Los Angeles)
• Christus Santa Rosa (San Antonio)
• Crozer-Chester Medical Center (Upland, Pa.)
• Delaware County Memorial Hospital (Drexel Hill, Pa.)
• Des Peres Hospital (St. Louis)
• Desert Regional Medical Center (Palm Springs, Calif.)
• Exempla Good Samaritan Medical Center (Lafayette, Colo.)
• Exempla Lutheran Medical Center (Wheat Ridge, Colo.)
• Exempla Saint Joseph Hospital (Denver)
• Florida Hospital Orlando
• Fountain Valley (Calif.) Regional Hospital
• Glendale (Calif.) Memorial Hospital and Health Center
• Jersey Shore University Medical Center (Neptune, N.J.)
• JFK Memorial Hospital (Indio, Calif.)
• Lakewood (Calif.) Regional Medical Center
• Lancaster (Pa.) General Hospital
• Los Alamitos (Calif.) Medical Center
• Mercy Medical Center (Canton, Ohio)
• Methodist Hospital of Southern California (Arcadia, Calif.)
• Missouri Baptist Medical Center (St. Louis)
• NewYork-Presbyterian Hospital (New York City)
• Northern Dutchess Hospital (Rhinebeck, N.Y.)
• Paradise Valley Hospital (Phoenix)
• Phoenix Baptist Hospital/Arizona Heart Hospital
• Placentia-Linda Hospital (Placentia, Calif.)
• Pomerado Hospital (Poway, Calif.)
• Providence Hospital (Columbia, S.C.)
• Providence Hospital Northeast (Columbia, S.C.)
• Putnam Hospital Center (Carmel, N.Y.)
• Rothman Specialty Hospital (Bensalem, Pa.)
• Saint Francis Hospital (Memphis, Tenn.)
• Saint Francis Hospital-Bartlett (Tenn.)
• St. Francis Health Center (Topeka, Kan.)
• St. Joseph's Hospital & Medical Center (Phoenix)
• St. Luke's Hospital (Chesterfield, Mo.)
• St. Mary Medical Center (Calif.)
• St. Rose Dominican Hospitals – Rose de Lima Campus (Henderson, Nev.)
• St. Rose Dominican Hospitals – San Martin Campus (Las Vegas)
• St. Rose Dominican Hospitals – Siena Campus (Henderson, Nev.)
• St. Vincent Healthcare (Billings, Mont.)
• Scottsdale (Ariz.) Healthcare Osborn Medical Center
• Scottsdale (Ariz.) Healthcare Shea Medical Center
• Scripps Green Hospital (La Jolla, Calif.)
• Scripps Memorial Hospital Encinitas (Calif.)
• Scripps Memorial Hospital La Jolla (Calif.)
• Scripps Mercy Hospital (San Diego)
• Shore Medical Center (Somers Point, N.J.)
• Sparrow Hospital (Lansing, Mich.)
• Staten Island (N.Y.) University Hospital
• Summa Akron (Ohio) City Hospital
• Summa Barberton (Ohio) Hospital
• Summa St. Thomas Hospital (Akron, Ohio)
• Sutter Medical Center (Sacramento, Calif.)
• Torrance (Calif.) Memorial Medical Center
• UCSF Medical Center (San Francisco)
• University of Colorado Hospital (Aurora)
• Valley Baptist Medical Center – Brownsville (Texas)
• Valley Baptist Medical Center – Harlingen (Texas)
• Vassar Brothers Medical Center (Poughkeepsie, N.Y.)
• West Valley Hospital (Goodyear, Ariz.)
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