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BLOG: Centers for Medicare and Medicaid Innovation announces new options for Bundled Payments for Care Improvement initiative

From international law firm Arnold & Porter LLP comes timely views on current regulatory and legislative topics that weigh on the minds of today’s physicians and health care executives.

Ted Lotchin

Historically, Medicare has paid providers for discrete services to treat a single illness or patient interaction. This model has been widely criticized for basing payment on how much a provider does, rather than on the quality of care or treatment outcomes. As directed by the Affordable Care Act, the Centers for Medicare and Medicaid Innovation (CMMI) has worked over the past 12 months to implement a demonstration program to evaluate payment models based on bundles of services provided across a patient’s entire experience of care. Under the Bundled Payments for Care Improvement initiative (BPCI), payments for multiple services provided during a course of treatment would be linked together.

CMS has been actively soliciting applications from providers interested in participating in the BPCI. The agency initially planned to allow each participant to define its own episodes of care for payment purposes. On Nov. 30, the CMMI reversed course a bit and released a proposed list of 48 episodes of care from which participating providers would be required to choose. The proposed episodes cover more than 200 diagnosis-related groups that account for roughly 70% of Medicare spending, including heart attack, hip and knee surgery, COPD and renal failure.

More information about the BPCI is available here.

Ted Lotchin, JD, MPH, can be reached at Arnold & Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-5250; email: Ted.Lotchin@aporter.com