Noteworthy News

CMS Unveils New Bundled Payment Program

The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.”  Under this new program – participation in which will be voluntary – participants can, as CMS explains

…earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.

The following are a few highlights of BPCI Advanced.

  • It encompasses 32 types of clinical episodes (29 inpatient and three outpatient).  These episodes, of 90 days, may change in the future.
  • Participating providers can waive the Medicare requirement that patients spend at least three days in a hospital before Medicare will cover nursing home care.
  • The program includes a waiver of geographic requirements for Medicare reimbursement for telehealth services.
  • Participating providers will be required to assume downside financial risk from day one, currently scheduled for October 1, 2018.
  • The program will run from October 1, 2018 through 2023, with a second opportunity for providers to apply to participate in 2020.
  • CMS considers BPCI Advanced an alternative payment model (APM) under MACRA), which exempts participating physician groups from possible Medicare reimbursement cuts.

Find additional information about BPCI Advanced from CMS’s news release announcing the program and from the BCPI Advanced web page.

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