CMS’ latest payment model, Bundled Payments for Care Improvement Advanced, could affect provider participation in other alternative payment models (APMs) like accountable care organizations (ACOs), according to a new Health Affairs blog.
The post looked at the issues connected to an overlap of the BPCI-A initiative and the Medicare Shared Savings Program (MSSP), as well as potential implications for policymakers and participating providers.
If physicians and hospitals take part in both programs, the competing payment models may affect provider incentives and payments, the authors wrote.
Medicare’s BPCI-A, which starts in October, is the latest value-based payment model from CMS. It requires organizations to accept a 3% price discount. Newer ACO models also dictate more cost accountability than previous models.
The Health Affairs post said APM participation will likely increase once BPCI-A and other ACO models roll out, which means payment model overlap may present an increasing problem in the coming years.
The report highlighted potential BPCI and MSSP overlap. The BPCI “emphasizes accountability for episodes beginning with hospitalization and spanning a period of post-acute care.” MSSP “emphasizes global accountability for overall quality and costs over the course of a year, thereby emphasizing care management of both outpatient and hospital care.”
The two programs could complement one another by reducing hospitalization and improved hospital and post-acute care quality. Or, the APMs may overlap in quality and cost accountability. One example is if patients receive some care from MSSP providers and other care from BPCI providers for the same condition.
That overlap “may have far-reaching impact on provider incentives and behavior,” according to the post, which offered some solutions CMS may implement to resolve the problem.
For instance, when the two programs overlap in markets and provider organizations, Medicare could decide not to pursue “financial recoupment from the BPCI Advanced provider.”
The post authors emphasized the need for CMS to address overlap concerns. “Given the continued growth in both APMs, their importance to Medicare’s overall value-based strategy and the financial and operational implications of overlap for participating clinicians and hospitals, this is an urgent policy issue,” according to Health Affairs.