CMS extends bundled payments to 2025
The Centers for Medicare and Medicaid Services (CMS) has extended the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model for another two years.
Instead of concluding Dec. 31, 2023, the program is now scheduled to end Dec. 31, 2025. It launched on Oct. 1, 2018. The BPCI model is an Advanced Alternative Payment Model (AAPM) that is part of the Quality Care Program and ties payments together for an episode of care. The aim of the model is to incentivize care coordination among healthcare providers and to practice care innovation and reduce expenditures while also improving care quality for Medicare beneficiaries.
More than 1.2 million Medicare beneficiaries have received care from participants in BPCI as of Dec. 31, 2021, with more than 1,800 Acute Care Hospitals (ACHs) in coordination with 69,867 physicians engaged in care redesign under the model. The model has also proven to lower healthcare spending without reducing quality in its first two years.
The two-year extension also comes with a new application opportunity for providers and suppliers that want to participate. CMS plans to announce a Request for Applications (RFA) in early 2023 for Medicare-enrolled providers and suppliers and Medicare Accountable Care Organizations (ACOs) to participate in 2024 and 2025. Eligible providers must be ACOs or Medicare-enrolled entities. Existing participants in BPCI will be able to participate in 2024 and 2025.
In addition to announcing a two-year extension, CMS published the changes to the 2023 BPCI program, which the agency can do “to strike a balance between participation incentives and the need to meet statutory requirements to either improve quality without increasing spending, reduce spending without reducing quality or improve quality and reduce spending,” it said. According to CMS, the two-year extension of the program will allow the agency to test and evaluate the 2023 changes for the future.
The 2023 changes include reducing the CMS Discount for medical clinical episodes from 3% to 2%, holding participants accountable for all clinical episodes when the patient has a COVID-19 diagnosis during the clinical episode and more.
CMS made changes to the BPCI in 2020 that aimed to help alleviate the burden of participants when it came to COVID-19 diagnoses due to limited availability of staff and unpredictable healthcare expenses due to the pandemic. Beneficiaries who had a COVID-19 diagnosis during the episode of care were excluded from Model Reconciliation and the participant’s financial responsibility associated with COVID-19 clinical episodes were eliminated.
However, after three years of this policy, BPCI participants are concerned about lower volumes in the model as a result of those exclusions. With the addition of better treatments and COVID-19 vaccines, healthcare providers are better equipped to manage COVID-19 patients in episodes of care, and therefore CMS has changed Model Year 6 (2023) to include these beneficiaries in the model once again. Participants will be accountable for clinical episodes where the BPCI Advanced beneficiaries have a COVID-19 diagnosis during the episode of care.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."