Participants Named for Medicare Bundled Payment for Care Improvement - Advanced Model

Posted on October 12, 2018

The Centers for Medicare & Medicaid Services (CMS) recently announced participants for the Medicare Bundled Payment for Care Improvement – Advanced (BPCIA) payment model that began Oct. 1 and will run through Dec. 31, 2023. Nationally, there are 1,547 participants, comprised of 832 acute care hospitals and 715 physician group practices. In Michigan, 40 healthcare providers are participating.

This program builds on the BPCI initiative that ended Sept. 30 and includes 29 inpatient and three outpatient episodes of care. An episode is defined as all Medicare fee-for-service covered care provided during an acute care admission and 90 days post-discharge. Participants assume financial risk for patients’ healthcare costs and can qualify for incentive payments. The BPCIA qualifies as an Advanced Alternative Payment Model under the Medicare Access & CHIP Reauthorization Act (also known as MACRA), so participating providers can be exempted from the reporting requirements associated with the physician Merit-Based Incentive Payment System.

The top three episodes selected for participation by providers were:

  • Major joint replacement of the lower extremity.
  • Congestive heart failure.
  • Sepsis.

The CMS will provide a second application opportunity in January 2020. DataGen is available to assist hospitals with BPCIA analytics on a fee basis. Interested hospitals should contact Darcie Hurteau at DataGen. Members with questions should contact Vickie Kunz at the MHA.

Tags: bundled payments, BPCI Advanced program, BPCI Advanced, BPCIA

Posted in: Member News

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