CMS launches new bundled payment model: 6 things to know

CMS announced a new voluntary bundled payment model on Tuesday, which is the first advanced alternative payment model introduced by the Trump administration.

Here are six things to know about the bundled payment model.

1. The new model, called Bundled Payments for Care Improvement Advanced, includes 32 clinical episodes, with 29 in the inpatient setting and three in the outpatient setting. The clinical episodes may change in the future, as CMS may elect to revise them on an annual basis beginning Jan. 1, 2020.

2. 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.

3. CMS selected seven quality measures for BPCI Advanced. Two of them, the all-cause hospital readmission measure and the advanced care plan measure, will be required for all clinical episodes. The other five measures will only apply to select clinical episodes.

4. BPCI Advanced will qualify as an advanced APM under the Quality Payment Program, meaning participants will be eligible for bonuses under the Medicare Access and CHIP Reauthorization Act.

5. The first cohort of providers will start participation in the model Oct. 1, and the performance period will run through Dec. 31, 2023. Providers selected to participate in BPCI Advanced beginning Oct. 1 must be held accountable for at least one clinical episode and may not add or drop clinical episodes until Jan. 1, 2020.

6. Providers have until March 12 to apply. CMS will provide a second application opportunity for BPCI Advanced in January 2020.

Access more information about BPCI Advanced here.

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