CMS Announces New Voluntary Bundled Payment Model
January 26, 2018 | Aging Services Risk Management
The Centers for Medicare and Medicaid Services (CMS) has announced Bundled Payments for Care Improvement Advanced (BPCI Advanced), a new voluntary model of bundled payments for 29 inpatient and three outpatient clinical episodes. Bundled payments combine the payments for physicians, hospitals, and other healthcare providers into a single payment. Under BPCI Advanced, the amount of the single payment is calculated based on the expected costs of all items and services during an episode of care; providers may experience gains or losses. BPCI Advanced also includes seven quality measures. Two of them, which address all-cause hospital readmissions and advance care planning, will be required for all clinical episodes. Acute care hospitals, physician group practices, eligible entities that are Medicare-enrolled providers or suppliers, and eligible entities that are not enrolled in Medicare can participate as convener participants. Conveners bring together multiple downstream entities; they facilitate coordination and bear and apportion financial risk. Acute care hospitals and physician group practices can participate as nonconvener participants.