Here are five things to know:
1. Hospitals owned by San Francisco-based Dignity Health, Dallas-based Tenet Healthcare and Nashville, Tenn.-based HCA Healthcare are among those participating in BPCI Advanced. A full list of providers participating in the program can be found here.
2. The performance period for the first cohort of providers began Oct. 1 and runs through Dec. 31, 2023.
3. The bundled payment model, which CMS unveiled in January, currently includes 32 clinical episodes, with 29 in the inpatient setting and three in the outpatient setting. CMS said the top three clinical episodes currently selected by participants are: major joint replacement of the lower extremity, congestive heart failure, and sepsis.
4. Under the program, provider payments will be based on quality performance during a 90-day episode of care. A clinical episode will begin at the start of an inpatient admission to an acute care hospital, which CMS referred to as the “anchor stay,” or at the beginning of an outpatient procedure, the “anchor procedure.” The clinical episode will end 90 days after the end of the anchor stay or the anchor procedure.
5. BPCI Advanced qualifies as an advanced APM under the Quality Payment Program, meaning participants will be eligible for bonuses under the Medicare Access and CHIP Reauthorization Act.
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