On October 9, 2018, the Centers for Medicare & Medicaid Services (CMS) announced that close to 1,300 entities (conveners or single hospitals or physician group practices) have signed agreements to participate in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model on a voluntary basis. The announcement can be found here: https://www.cms.gov/newsroom/press-releases/cms-announces-participants-new-value-based-bundled-payment-model. This program is the next round of episodic payment and replaces BPCI “Classic”, which ended September 30, 2018.
All 1,547 hospitals and physician groups participating in this round of bundling will have a few short months to make a firm decision on whether to take full risk for a 15-month period and, if so, for which clinical episodes (defined as diagnostic clusters, which include up to 29 categories triggered by an inpatient stay, and three triggered by outpatient services).
Many clinical episodes, such as hip fractures, have a strong post-acute focus in the 90-day post-hospital discharge period. Our experience with episodic risk-based models is that post-acute care can often be the most highly variable component of a 90-day episode, but the good news is that under the right incentive structure, post-acute providers can successfully manage risk of a wide range of clinical categories, including medically complex care as well as orthopedic care.
Participating hospitals and physician group practices often form preferred provider relationships in order to successfully manage under the bundle. However, preferred networks will only take you so far. From our perspective, bundlers should also develop and implement risk-sharing with post-acute care in order to ensure consistent and superior performance. In so doing, bundlers will be able to opt in for more clinical categories than they might otherwise have done and, thus, scale their program.
Authored by: Brian Ellsworth, Vice President for Public Policy and Payment Transformation