CMS has extended several deadlines for the agency's new voluntary bundled payment model, called the Bundled Payments for Care Improvement-Advanced Model (BPCI-Advanced).
Details on BCPI-Advanced
CMS announced BCPI-Advanced in January, less than two months after the agency canceled and scaled-back several mandatory bundled payment models created under former President Barack Obama's administration. BPCI-Advanced is the first model introduced under the Trump administration that will qualify as an Advanced Alternative Payment Model under MACRA's Quality Payment Program.
Under BPCI-Advanced, participating clinicians can receive bundled payments for up to 32 different clinical conditions—including 29 inpatient care episodes and three outpatient care episodes—for which they will be held accountable for cost and quality.
Those payments will be paid for retrospective, 90-day episodes of care and will be eligible to "earn additional payment if all expenditures for a beneficiary's episode of care are under a spending target that factors in quality," according to a CMS release. CMS said bundled payments for the episodes will be "calculated based on the expected costs of all items and services furnished to a beneficiary during an episode of care," and participating providers "may either realize a gain or loss, based on how successfully they manage resources and total costs throughout each episode of care."
Clinicians' quality performance on selected care episodes will be determined based on seven quality metrics:
- All-cause Hospital Readmissions;
- Advanced Care Plan;
- Agency for Healthcare Research and Quality Patient Safety Indicators;
- Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction;
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary Artery Bypass Graft Surgery;
- Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty; and
- Perioperative Care: Selection of Prophylactic Antibiotic: First or Second Generation Cephalosporin.
CMS said the All-cause Hospital Readmission and Advanced Care Plan metrics will apply to all care episodes, while the remaining five measures will apply only to some of the care episodes.
CMS began accepting applications for the new model via a portal on Jan. 11. CMS said convener participants—those "that brin[g] together multiple downstream entities, referred to as 'Episode Initiators'—may include:
- Acute care hospitals;
- Medicare-enrolled providers or suppliers;
- Eligible entities not enrolled in Medicare; and
- Physician group practices.
The agency said acute care hospitals and physician group practices also may be non-convener participants in the model. According to CMS, non-convener participants would themselves be Episode Initiators and would "not bear risk on behalf of multiple downstream Episode Initiators."
The model's first performance period is scheduled to launch Oct. 1 and run through Dec. 31, 2023.
CMS extends deadlines
CMS this week extended the deadline for providers to submit signed participation agreements and select clinical episodes for BPCI-Advanced from Aug. 1 to Aug. 8. In addition, CMS extended the deadline for providers to submit deliverables to CMS under BPCI-Advanced to Sept. 14, Becker's Hospital CFO Report reports.
According to Becker's Hospital CFO Report, the American Hospital Association (AHA) in a letter sent to CMS in June had asked the agency to extend the Aug. 1 deadline, noting that CMS did not provide potential applicants with a complete suite of data—including episode target prices and raw claims data—to conduct analyses and determine whether to participate in the new until June. As a result, AHA said applicants would have less than two months to conduct the necessary analyses to decide whether to participate in BPCI-Advanced before the Aug. 1 deadline.
Keely Macmillan, general manager of BPCI-Advanced at Archway Health, said the new deadline gives providers two months, which CMS initially had offered them, to review their data before they decide whether to participate in BPCI-Advanced. "It gives a little bit a breathing room for a provider already looking at data and thinking about how to be successful in the program," Macmillan said (Ellison, Becker's Hospital CFO Report, 7/5; Morse, Healthcare Finance News, 7/5; Dickson, Modern Healthcare, 7/5).
August 2 webconference: The 2018 MIPS Cost Category Decoded
The Medicare Access and CHIP Reauthorization Act (MACRA) mandates pay-for-performance for Medicare clinicians in the Quality Payment Program’s Merit-Based Incentive Payment System (MIPS).
Join the 30-minute webconference on Thursday, August 2 where we'll dive into the metrics included in the 2018 MIPS Cost category, how providers’ scores will be calculated, and strategies for improving performance.