The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday, almost 1,300 providers have signed themselves up to test-drive the Bundled Payment for Care Improvements (BPCI) advanced model.
Among the Arizona participants are:
- Desert Institute Spine Care
- Desert Orthopedic Specialists
- Flagstaff Medical Center
- Sonoran Orthopaedic Trauma Surgeons
- Tucson Orthopaedic Institute
- Verde Valley Medical Center
The advanced payment model is entirely voluntary and is a new iteration of bundled payments for 32 clinical episodes, aiming “to align incentives among participating health care providers for reducing expenditures and improving quality of care for Medicare beneficiaries,” according to CMS.
This model was announced in January of 2018 and is to run from Oct. 1 all the way until Dec. 31, 2023. Under the advanced model, providers have agreed to receive bundled payments for certain episodes under Medicare, rather than the fee-for-service model that pays according to individual services. According to a report by The Lewin Group however, the BPCI program has resulted in a loss of Medicare dollars–costing almost $300 million from 2013 to 2016.
The report states, “under the BPCI initiative, Medicare payments declined for most clinical episodes and over half of the relative payment reductions were statistically significant.” Ultimately, the BPCI program lost money due to the reconciliation payments that had to be administered to providers that met key performance benchmarks.
The BPCI Advanced program replaces the July 1 initiative that accumulated 1,025 participants. The current program includes a total of 832 acute-care hospitals and 715 physician group practices. CMS paid special attention to risk when developing the Advanced model as participants can earn additional payments if a beneficiaries episodes of care expenses are less than the targets spending, but on the downside must repay Medicare for exceeding expenses.
Read more about the program at Healthcare Finance.
For more information on the model, visit CMS’ site.
And check out Skilled Nursing News’ comparison of the two BPCI models.