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CMS recently distributed a press release indicating its intent to open the application period for Model Year 3 of the Bundled Payments for Care Improvement (BPCI) Advanced Model. Participants who successfully apply in this second cohort will begin the program on January 1, 2020. CMS has indicated this will likely be the last enrollment period for the five-year Advanced Alternative Payment Model (APM) under the CMS Innovation Center Program.

BPCI Advanced consists of 32 bundled clinical episodes—29 inpatient and three outpatient. CMS also is finalizing the selection of new clinical episodes for Model Year 3, which will include outpatient Total Knee Arthroplasty.

You should expect questions and renewed interest from your physicians and local market health care partners. In year two of the program alone, the Model Episode Initiators included 715 acute-care hospitals and 580 physician group practices—a total of 1,295 Medicare providers.

BPCI Advanced can be a lower-barrier entry point to gaining experience in managing beneficiary cost and quality risk for some organizations. Simply applying to the program doesn’t require your organization to participate. It does allow your leaders and physicians to obtain rich, detailed beneficiary claims data on organization historical performance from a CMS bundles standpoint. This same data also helps facilitate strategic decision making on whether you’re prepared to move forward in a value-based reimbursement environment or can help identify areas of opportunity within your organization and market.

Key Considerations

  • Voluntary program with ability to terminate after 90 days’ notice
  • Likely just a two-month application window starting in April
  • Claims data and target prices will be provided after initial application is submitted
  • Program begins January 1, 2020, and continues until December 31, 2023
  • Program is a retrospective bundle, meaning fee-for-service payments will continue under current methodologies for all providers (hospital, home health, skilled nursing, Part B, etc.) and the episode will be reconciled semiannually against target prices to determine gains or losses
  • Participants can select their own bundles from the following:
    • 105 MS-DRGs will be grouped into 29 inpatient episodes to choose from
    • 30 HCPCS codes will be grouped into three outpatient episodes to choose from
  • BPCI Advanced will qualify as an Advanced APM under MACRA
  • There will be a 20 percent stop-gain and 20 percent stop-loss provision to limit excessive earnings and losses
  • The reconciled payment amount will be adjusted with quality indicators

How BKD Can Help

BKD has successfully helped many BPCI Advanced hospitals and physicians. Many of our clients have capped out on gains and continue to look for new bundled payment opportunities. Our team of clinicians, data analysts and service-line leaders is prepared to help you in the following ways:

  • Application process (two months to apply)
  • Strategic data analysis to help determine if BPCI Advanced is a good clinical and business decision for your hospital/PGP
  • Episode selection
  • Program development and structure
  • Best practices for care pathways, clinical risk management, discharge protocols, waiver utilization, identification and development of post-acute network
  • Physician engagement and alignment
  • Gainsharing development and implementation
  • Ongoing monitoring of episodic claims data with BKD Outcomes Compass™, our online dashboard

For questions or to learn more, contact Eric Rogers, Zach Remmich or Cindi Goddard.

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