Dive Brief:
- Since October, the Centers for Medicare & Medicaid Services (CMS) has begun requiring all participants in its voluntary Bundled Payment for Care Improvement (BPCI) program to take on downside risk for all program bundles.
- With that change came some reduction in participation. The approximately 1,500 providers still participating represent about 25% of those that had previously expressed interest in the program, reports a recent Avalere analysis.
- This drop in participation could impact CMS' decision on whether to continue offering voluntary demonstrations, or transition to mandatory programs along the lines of the Comprehensive Care for Joint Replacement (CJR) program.
Dive Insight:
Despite the decrease, Avalere still describes the program participation level as strong, and an indicator of providers’ willingness to experiment with alternative payment models.
“However, the fact that many providers that entered the program decided it’s not currently in their financial interest to accept downside risk may cause CMS to consider additional mandatory programs in the future,” says Avalere Senior Vice President Josh Seidman.
At the same time, those who stayed in the program have on average expanded their participation, Avalere says.
Before October, providers were able to test treatment episodes from the program's 48 clinical conditions without holding any responsiblity if they went above the target price, simply receiving access to program data and target prices to allow them to determine their interest in the program.