CMS Launches Voluntary Bundled Payment Model

The Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation has launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Whereas Medicare pays providers for each individual service performed under traditional fee-for-service payment, under the BPCI Advanced model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. Participants may receive payments for performance on 32 different clinical episodes such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient). The goal is to create incentives for providers and practitioners to work together to coordinate care and engage in continuous improvement to keep spending under a target amount. BPCI Advanced also qualifies as an Advanced Alternative Payment Model, under which providers take on financial risk to earn incentive payments.

According to CMS, the BPCI Advanced model takes into account rigorous evaluation results from previous models, industry experience with bundled payment, and stakeholder input from healthcare providers at acute care hospitals, physician group practices and other providers and suppliers. The model starts Oct. 1, 2018, and continues through Dec. 31, 2023. More information about the model, its requirements and application process can be found at innovation.cms.gov/initiatives/bpciadvanced.