Speaker discusses differences between BPCI Advanced and original BPCI, CJR

At the National ACO, Bundled Payment and MACRA Summit, presenters discussed how the Bundled Payments for Care Improvement Advanced initiative differs from the original BPCI and the Comprehensive Care for Joint Replacement.

With BPCI Advanced, participants can opt into participation similar to the original BPCI, according to L. Daniel Muldoon, MA, health care consultant at Milliman. He added only acute care hospitals and physician group practices can initiate episodes in BPCI Advanced, a practice that differs from the original BPCI, which allowed acute care hospitals, physician group practices and post-acute care facilities to initiate episodes, and the Comprehensive Care for Joint Replacement (CJR), which allows only acute care hospitals to initiate episodes.

“In terms of episode types, the original BPCI had 48 episodes. They were all inpatient based,” Muldoon said. “They were either acute care plus 30, 60 or 90 days of post-acute care or post-acute care only that began after an inpatient admission to CJR.”

In BPCI Advanced, Muldoon said the option for choosing the length of the post-acute period has been removed, leaving post-acute care plus 90 as the only available option. BPCI Advanced also has more minimal service exclusions compared to other models, according to Muldoon.

“It has fewer excluded [diagnosis-related groups] DRGs for readmission, as well as a streamlined part B exclusion, which basically excludes part B services that occurred during an admission,” he said.

CMS has also incorporated factors based on peer group characteristics “that would allow historically efficient providers to still be successful” in keeping to a target price, Muldoon noted. Another aspect of target price comparison is a patient case mix adjustment factor “that updates the price for the participant’s experience in terms of the patient case mix,” he said.

“With the advent of a more complicated risk adjustment methodology, it becomes a little more difficult for participants to understand,” Muldoon said. “I think we also saw this play out with the oncology care model, which is another voluntary episode payment model that CMS has that uses a regression-based risk adjustment model to account for patient case mix. I think it is not necessarily as straight forward how to calculate the prices, even though the idea of adjusting for patient case mix is core to being able to set accurate prices.” – by Casey Tingle

Reference:

Examining BPCI Advanced: How have we “advanced" since the original models? Presented at: The National ACO, Bundled Payment and MACRA Summit; June 6-8, 2018; Washington, D.C.

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