CMS will allow participants in the Bundled Payments for Care Improvement Advanced (BPCI-A) model withdraw retroactively from all or some episode initiators and clinical episodes in March.
CMS said it is keeping the Oct. 1 start date.
The American Hospital Association has asked CMS to give providers more time to consider participation. While the agency decided not to delay implementation of the program, it said allowing providers to drop out retroactively is a move to “recognize some applicants’ requests for a later start date.”
BPCI-A is a voluntary value-based bundled payment program for acute care hospitals and physician group practices. It covers 32 clinical episodes, including 29 inpatient and three outpatient. BPCI-A will expand value-based care as CMS will tie payments with quality measures. The program requires organizations to accept a 3% price discount.
Once it kicks off in October, BPCI-A will be considered an advanced alternative payment model (APM) for MACRA reporting. BCPI-A is the Trump administration’s first major initiative of the Center for Medicare and Medicaid Innovation. The voluntary design is a distinct move away from the mandatory programs of the Obama administration.
Clay Richards, CEO at naviHealth in Brentwood, Tennessee, told Healthcare Dive on Tuesday that CMS’ decision shows the agency’s willingness to provide flexibility. Allowing providers to withdraw retroactively creates “a trial-and-error period without significant consequences,” he said.
Richards suggested the move may encourage more hospitals and physician group practices to participate in additional episode groups.
Mandatory versus voluntary programs remains a heated debate that often pits researchers versus doctors.
A mandatory program ensures that enough doctors are involved, which produces enough data to determine a program’s effectiveness. A recent Health Affairs study said mandatory bundled payment programs “generate robust evidence and either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payments.”
However, many providers push back against mandatory programs because of the administrative burden and added risk. Instead, they would prefer voluntary programs so they can choose ones that make sense for their practices.