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BPCI Advanced to include bundled payments for 3 outpatient clinical episodes: 5 insights

CMS announced 1,299 entities agreed to participate in the agency's bundled payment initiative for certain episodes of care under the Bundled Payments for Care Improvement – Advanced Model.

Here's what you should know:

1. Under BPCI Advanced, participants can earn an additional payment if all expenses for a beneficiary's episode of care fall below a spending target, but they must repay money to Medicare if expenditures exceed the target price.

2. Unlike the original BPCI Initiative, which ended Sept. 30, the new model offers bundled payments for outpatient episodes. BPCI Advanced will initially include three outpatient bundled clinical episodes and 29 inpatient ones. The new model runs from Oct. 1, 2018, through Dec. 31, 2023.

3. Participants, which include 832 acute care hospitals and 715 physician group practices, selected major joint replacement of the lower extremity, congestive heart failure and sepsis as the top three clinical episodes.

4. BPCI Advanced qualifies as an Advanced Alternative Payment Model under MACRA, so participants can be exempted from Merit-Based Incentive Payment System requirements. They will also be given preliminary target prices before the model year begins to facilitate planning.

5. Also on Oct. 9, CMS released an evaluation report for original BPCI Initiative models, calling the results "encouraging." 

Find more information about the BPCI Advanced Model here

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