CMS Launches New Voluntary Bundled Payment Model

In a continued move toward value-based care that shifts to information technologies that better manage care, risk and cost, the Centers for Medicare and Medicaid Services (CMS) has launched a new voluntary bundled payment model that qualifies as an advanced alternative payment model (APM) under its quality payment program (QPP). The new model, called Bundled Payments for Care Improvement (BPCI) Advanced, is part of the BPCI initiative developed by the Centers for Medicare and Medicaid Innovation to test innovative payment and service delivery models that could reduce Medicare, Medicaid and Children’s Health Insurance Program expenses while preserving or enhancing the quality of care for beneficiaries. Participants will receive payments for performance on 32 different clinical episodes such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient).

“BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and toward paying for value,” said CMS Administrator Seema Verma. “In BPCI Advanced, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on specialty quality measures. Participants bear financial risk, have payments under the model tied to quality performance and are required to use Certified Electronic Health Record Technology.”