CMS on Monday launched its new voluntary bundled payment model with 1,299 participating entities, and while some participants are excited about the model's prospects, others already are contemplating leaving the model, Modern Healthcare reports.
CMS launches BPCI-Advanced
CMS announced the payment model, called the Bundled Payments for Care Improvement-Advanced Model (BPCI-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."
The model's first performance period launched Oct. 1 and is scheduled to run through Dec. 31, 2023. CMS on Tuesday announced that 1,299 entities had signed agreements to participate in the model, including 832 acute care hospitals and 715 physician group practices. CMS said a total of 1,547 Medicare providers and suppliers located throughout 49 states, Washington, D.C., and Puerto Rico signed agreements to participate in the model.
Some participants are optimistic
Some participants have expressed excitement over the new model, Healthcare Finance News reports.
Chris Garcia—CEO of Remedy Partners, a convener for participants in the model—said BPCI Advanced will benefit patients by keeping providers focused on care that can bolster patient outcomes, such as helping to arrange home care or Meals on Wheels for their patients. "Patients really are benefitting from this program," he said, adding, "We're doing a more thoughtful job. There's a financial incentive in place to do that."
Carter Paine—COO for naviHealth, a convener company with more than 150 hospitals participating in BPCI Advanced—said the model "has been identified as this way of getting better clinical outcomes and mak[ing] good money doing it."
Others are eyeing an exit
But some participants already are contemplating leaving the new model, Modern Healthcare reports. According to Healthcare Finance News, participants in March 2019 will have an opportunity to exit the payment model.
Gina Intinarelli, executive director of population health and accountable care at UCSF Medical Center, has said her organization might choose to exit the payment model because they did not have enough time to prepare, Modern Healthcare reports.
According to Modern Healthcare, CMS was delayed in giving health care providers the claims data they needed to evaluate which bundles to participate in under the model. Intinarelli said once that data was in hand, her team realized UCSF would be "starting … at least $1 million in the hole that we would have to make up before we would ever get shared savings." Intinarelli said UCSF is hoping to break even under the model, but will not rule out exiting the model if needed.
Greg Sheff—CMO at AccentCare, which is a BPCI Advanced convener and a home health and hospice provider—said the comparably lower target prices participants must meet under the new model "is a race to the bottom in the sense that there isn't enough to incentivize providers." He added, "I understand the desire for Medicare to push risk but at the same time you can't create a situation where there is not enough viable opportunity."
Jessica Walradt, program manager of value-based care at Northwestern Medicine, said CMS should implement a floor for target prices as providers improve care under the bundles. "If there's not a floor, then it's going to keep moving the goal posts to such an extent that there won't be sufficient room for providers to produce savings," she said. Walradt said that concern could cause providers to stop participating in the model. "I think people are absolutely going to use the March off-ramp," she said.
A CMS spokesperson did not return a request for comment on the matter, Modern Healthcare reports (Dickson, Modern Healthcare, 10/6; CMS release, 1/9; CMS release, 10/9; Morse, Healthcare Finance News, 10/5).
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