by Jim Reilly
Senior Principal

In a previous blog, one of my colleagues shared information about CMS adding a second cohort to Bundled Payment for Care Improvement Advanced (BPCI Advanced), and the addition of outpatient total knee arthroplasty to this voluntary program, which provides utilization and spend data for hospitalization plus 90 days of the episode. The application period for the second cohort opened on April 24 and will only be open until June 24. Episode payment models — in all their various forms — will stand the test of time, and there are strong reasons for health systems to take advantage of BPCI Advanced to advance their overall value-based payment strategy.

What Is BPCI Advanced?

To recap, BPCI Advanced is a CMS bundled payment program designed to further test a reimbursement mechanism that will fundamentally alter the reimbursement landscape. Organizations (hospitals or physician groups) can elect to participate in BPCI Advanced by selecting from a menu of more than 30 inpatient and outpatient clinical episodes, and there is no minimum number of episodes required for program participation. When a provider selects episodes, they will be responsible for managing not only the acute hospital stay for each patient, but also most services provided to patients in the 90-day post-discharge time frame.

Medicare challenges BPCI Advanced participants to reduce CMS’ historical spend for this acute and post-acute time frame and will reward organizations that are able to do so. As an incentive to participate, CMS will release pricing benchmarks in advance of the participation deadline. Organizations can then determine if they can reduce spend, coordinate care and align with their physicians before committing.

Should you apply?

I believe if you are not yet involved in BPCI Advanced, you should give serious consideration to submitting an application immediately, for three key reasons:

  1. The application is nonbinding—your organization is not committing to participation when you apply;
  2. Applicants gain access to insightful episodic spend and utilization data from CMS, which is information that has not typically been available before; and
  3. If you don’t apply now, you most likely won’t be able to join later, as CMS is indicating this is the last window of opportunity.

Take action now

Overall, the BPCI Advanced application, at the very least, offers an episode spend data opportunity that should be taken advantage of. The application period is open now, and the window is short. Consider this period an opportunity to collect valuable data that will help you make informed decisions about bundled payment participation, whether that’s through CMS, commercial payers or directly with employers.

Interested in learning more? Register now for our webinar on Wednesday, May 22 at 11 a.m. CT, when I’ll provide additional details about participation in this important program.  

About the author. With a health care career spanning more than 25 years, Jim Reilly has extensive experience in health care advisory services with hospitals, health systems and physician practices nationwide. The nature of his health care consulting includes hospital/physician alignment, value-based care initiatives, bundled payments, strategic planning, new service line development and implementation services. 

Published: May 8, 2019