- The CMS late on Tuesday announced a new voluntary bundled payment model. It will cover 32 clinical episodes, of which 29 are inpatient and three are outpatient.
- The Bundled Payments for Care Improvement Advanced (BPCIA) program will be considered an advanced alternative payment model (APM) for purposes of MACRA reporting. CMS will accept applications through March 12, and the performance period will start Oct. 1.
- The model will have voluntary participation, as opposed to the mandatory programs the CMS canceled late last year for cardiac and hip fracture episodes.
BCPIA is the first major initiative of the Center for Medicare and Medicaid Innovation (CMMI) under the Trump administration. CMS Administrator Seema Verma has repeatedly said she supports the overall movement toward value-based reimbursement, but felt the mandatory bundled models were too restrictive for providers.
Providers interested in bundled models will be happy to see that the new program counts as an advanced APM. While MACRA is generally considered a positive step away from fee-for-service reimbursement, providers have lamented the lack of choices for the APM track. The new bundled approach could be an avenue for those looking to get out of the Merit-based Incentive Payment System track.
Keely Macmillan, general manager of BPCI for Archway Health, which advises providers on bundles, told Healthcare Dive the model announced Tuesday aligns with her expectations, but she is disappointed there is no post-acute option.
"More than half of current BPCI participants are in the post-acute facilities, and we’ve seen great results from them," she said. "There are still more details to come from CMS, but with open enrollment starting so soon, it’s now time for providers and organizations to prepare for participation."
Healthcare professionals at the forefront of the value-based movement have been watching CMS carefully, wary the agency will continue to roll back initiatives begun in the Obama administration.
Those fears intensified when Verma issued a request for information that sought guidance on a “new direction” for CMMI. Former HHS Secretary Tom Price was a frequent and vocal critic of mandatory participation models, but the nominee to replace him — Alex Azar — said at a committee hearing Tuesday if a program “needs to be mandatory as opposed to be voluntary to get adequate data, then so be it.”
The American Hospital Association supports bundled payment models in general but has not pushed for them to be mandatory.
A number of experts, however, believe forcing certain providers to participate is necessary for a positive outcome and for determining how the model can be scaled up or replicated.
The new model builds on the original BPCI the CMMI launched five years ago.