The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.” Under this new program – participation in which will be voluntary – participants can, as CMS explains
…earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.
The following are a few highlights of BPCI Advanced.
- It encompasses 32 types of clinical episodes (29 inpatient and three outpatient). These episodes, of 90 days, may change in the future.
- Participating providers can waive the Medicare requirement that patients spend at least three days in a hospital before Medicare will cover nursing home care.
- The program includes a waiver of geographic requirements for Medicare reimbursement for telehealth services.
- Participating providers will be required to assume downside financial risk from day one, currently scheduled for October 1, 2018.
- The program will run from October 1, 2018 through 2023, with a second opportunity for providers to apply to participate in 2020.
- CMS considers BPCI Advanced an alternative payment model (APM) under MACRA), which exempts participating physician groups from possible Medicare reimbursement cuts.