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CMS unveils new voluntary bundled payment model

Jan 21, 2018

Less than two months after the Centers for Medicare and Medicaid Services (CMS) scrapped two mandatory bundled payment models created by the CMS Innovation Center under the Obama administration, the agency introduced a new voluntary bundled payment model—the Bundled Payments for Care Improvement Advanced (BPCI Advanced).

The new program includes 32 clinical care episodes, three of which are outpatient. Among the care episodes are major joint replacement of the lower extremity, spinal infusion and percutaneous coronary intervention. Home Health Care News noted that home health services would be eligible for reimbursement under BPCI Advanced.

Seven quality measures have been chosen for the new model, including the all-cause hospital readmission measure.

The performance period will start on Oct. 1 of this year and end on Dec. 31, 2023. Applications to participate in the first performance year must be submitted by March 12.

BPCI Advanced will qualify as an advanced alternative payment model (APM) under the Quality Payment Program.

Our Take: CMS got it right by making this program voluntary. No one likes the word mandatory, and previous bundles carried the stigma of forcing providers into something they didn’t want to do, or at least weren’t ready for. Perhaps it was a necessary evil: who would venture into the world of bundled payments without a push? But now, years into the experiment, some providers have learned that bundles can be very lucrative, if costs are fixed and predictable.


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