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November 2, 2017

The latest results are in from CMS' bundled payments initiative—and they're clear as mud

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    CMS has released a report on the third year of its voluntary Bundled Payments for Care Improvement (BPCI) initiative, which found that some episode payments yielded savings—but because of limited data, it's unclear whether those savings are directly related to BPCI, Virgil Dickson writes for Modern Healthcare.

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    The Center for Medicare and Medicaid Innovation (CMMI) in 2013 launched the Bundled Payments for Care Improvement (BPCI) initiative, which is comprised of four "broadly defined" care models that establish bundled payments for multiple services received during an episode of care.

    Models 1 and 4 apply to inpatient hospital care; Model 1 ended in 2016. Models 2 and 3 involve post-acute care.

    As of October, 1,191 participants were enrolled in BPCI, including acute-care hospitals, skilled-nursing facilities, and physician group practices.

    Analysis results

    The report, prepared by the Lewin Group, analyzed BPCI data for Models 2, 3, and 4 from late 2013 to fall 2015.

    The report found that Medicare payments per case for joint replacements decreased by 4.5%, or $1,273 each, and that congestive heart failure spending per case dropped by 3.6%, or $970 per case. But since many participating provoiders were involved in multiple value-based payment models, the report authors said it's difficult to say whether BPCI was the cause of the cost reductions.

    Further, the report authors found most surveyed participants were part of BPCI for only three quarters, which they determined is not enough time to see meaningful results.


    According to Modern Healthcare, some experts said the report highlights a downside of voluntary payment models.

    "With voluntary models you lose the ability to draw conclusions if results are applicable across all providers," said Cristina Boccuti, the associate director of the program on Medicare policy at the Kaiser Family Foundation.

    However, provider groups have said they favor voluntary payment models over the mandatory payment models that former President Barack Obama's administration had pursued.

    Joanna Hiatt Kim, the VP of payment policy at the American Hospital Association, said, "Hospitals should not be forced to bear the expense of participation in these complicated programs if they do not believe they will benefit patients."

    Darcie Hurteau, the director of the DataGen Group, a health care data analytics and policy firm, said CMS should "use these results to fine-tune the program so that more people can participate and be successful in the next iteration" (Dickson, Modern Healthcare, 10/31).

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