CMS Bundled Payment for Care Improvement Program
Hospitals interested in applying for the BPCI Advanced program should note that there are several options for their participation. However, participants will be limited only to options for which they submit applications by March 12, 2018. Therefore, to keep their options open hospitals must submit applications for any alternative structure that they later may wish to adopt.
The alternatives for hospitals are:
In the two current Medicare bundled payment programs, three different methodologies have been used to establish payment targets. In the BPCI program targets are based on each participant’s historical episode cost, with “cost” defined as all payments made by Medicare or beneficiaries for services provided to the beneficiary during the episode. In this program participants will achieve financial success by reducing episode costs below their historical levels.
by Jonathan Pearce, CPA, FHFMA and Darcie Hurteau
By Jonathan Pearce, CPA, FHFMA
Update 2/7/2018 – CMS has clarified some of the issues described in the article below. However, major questions in the following areas remain significant to potential participants. We hope that clarifications on these issues will be released shortly, since they will have a major effect on the episodes selected by participants.
by Jonathan Pearce and Darcie Hurteau
Update: the BPCI Advanced program was announced by CMS on January 9. Our initial comments on this program are in this article.
After several months of negotiations you've reached agreement with a contract physician group to provide hospitalist services in your hospital. This group has particular expertise in helping patients with multiple comorbidities and focuses on making sure that those patients get into the proper post-acute setting, which you hope will improve your performance in the Medicare Bundled Payment for Care Improvement (BPCI) CHF and COPD episodes in which you’re participating.
Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH
The Medicare Bundled Payment for Care Improvement (BPCI) program allows participants to assume financial risk for all Medicare services occurring within 30 to 90 day period after hospital discharge. Model 2 participants give up 2% of the episode target amount as a discount to CMS in 90-day episodes, but are allowed to retain any savings from Medicare cost reductions below the target amounts.
Initially some BPCI participants were intrigued with the idea of participating in limited, procedurally-based episodes such as percutaneous coronary interventions (PCI) episodes in the Medicare Bundled Payment for Care Improvement program.
Achieving success in the Medicare Bundled Medicare Bundled Payment for Care Improvement initiative requires analyzing historical data to identify the opportunities and risks associated in each of the episode families, as well as the other decision points in BPCI participation. Careful evaluation of opportunities and risks before making participation decisions can pay off significantly when the at-risk period begins.