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Medicare advanced bundled payment model application portal to close March 12
The CMS Center for Medicare and Medicaid Innovation recently launched the bundled payments for care improvement advanced, a new voluntary bundled payment model. Practices and hospitals must apply via an application portal, by March 12, 11:59 pm EST, before the portal closes.
The application portal first went live on Jan. 11, 2018. According to a press release from the CMS, applications will not be accepted if submitted via email. The bundled payments for care improvement advanced (BPCI Advanced) application portal may be assessed here: https://app1.innovation.cms.gov/bpciadvancedapp.
According to a CMS press release, under traditional fee-to-fee service payments, Medicare pays health care providers for each individual service they perform. Under the BPCI Advanced, participants may earn additional payment if the costs for a beneficiary’s episode of care are under a spending target that factors in quality. Participants may receive payment for performance on 32 different clinical episodes.
The BPCI Advanced reportedly supports health care providers who invest in practice innovation and care redesign to improvement quality and reduce costs. Under the quality payment program, the BPCI Advanced qualifies as an advanced alternative payment model (APM).
“CMS is proud to announce this administration’s first advanced APM,” Seema Verma, CMS administrator, said in the release. “BPCI Advanced builds on earlier success of bundled payment models and is an important step in the move away from fee-for-service and toward paying for value. Under this model, providers will have an incentive to deliver efficient, high-quality care.”
Participants will be expected to redesign their delivery of care to keep Medicare costs within a defined budget, while improving and maintaining performance of specific quality measures. Participants bear financial risk, have payments linked to quality performance and need to use certified electronic health record technology. The model qualifies as an advanced APM if it meets these requirements.
The model performance period for BPCI Advanced will start on Oct. 1, 2018 and go through Dec. 31, 2023. There will be a formal, independent assessment to evaluate the quality of care and changes in spending under the BPCI Advanced.
Reference:
https://innovation.cms.gov/initiatives/bpci-advanced
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-01-10.html
Editor’s Note: On Feb. 23, we changed the headline and lede of this article to clarify that the CMS application portal is closing March 12.
Perspective
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There are several important issues relevant to BPCI. The “quality=outcomes/cost” model to all payers and employers, as well as BPCI, will continue to move forward as the alternative payment model (APM) becomes more engrained in the orthopedic health care delivery system.
Total joint replacement has been targeted by CMS due to the significant cost of the episode of care (more than $6 billion for TKA and $2 billion for THA) when performed on a fee-for-service basis as opposed to a bundled payment approach which puts the provider at risk. There are several success stories using BPCI as a cost-savings model for CMS, and this has encouraged CMS administrator Verma to attempt to expedite this approach. Using the “advanced APM” concept, providers take on further financial risk to earn the APM incentive payment. Surgeons will have to use a “certified EHR” in order to participate and maintain outcome measurements which exhibit “quality” metrics. This “model performance period for BPCI Advanced” begins on Oct. 1, 2018.
For a surgeon to be successful with this model, they will have to have control of their OR environment and be committed to preoperative stratification and optimization to avoid “bundle buster” or “avalanche” cases which will occur if appropriate preoperative screening is not performed. Prolonged hospital stays for patients not properly screened or managed will dramatically increase costs, as well as financial risk, for the surgeon group. Patient selection will be “everything” and it will be critical for physician groups willing to participate in this trial to have appropriate software that optimizes and stratifies patients in order to avoid readmissions and complications due to poor patient selection.