BPCI Advanced: Guide to Understanding the Next Generation of Bundled Payments

On January 9, 2018, The Centers for Medicare & Medicaid Services (CMS) announced its next generation of bundled payments: Bundled Payments for Care Improvement Advanced (BPCI Advanced). And, just two days later, open enrollment began for the agency’s most innovative bundled payment program yet. Now, many providers are left asking, “What is BPCI Advanced and is it right for me?”

What is BPCI Advanced?

BPCI Advanced is the next generation of the original, voluntary Bundled Payments for Care Improvement (BPCI) initiative announced by Medicare in 2011, and a further progression of the value-based healthcare movement.

The are several high-level factors that are important to understand about the new program. BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM) under the MACRA Quality Payment Program. With Advanced APMs, providers have a chance to receive an automatic 5% payment bonus with the opportunity to earn more based on performance, and avoid downside risk and additional quality reporting requirements under the Merit-Based Incentive Payment System (MIPS). BPCI Advanced is the first chance for many specialists to qualify for these opportunities with APMs.

How is BPCI Advanced different from the original model?

CMS has slimmed the BPCI Advanced program down from 48 bundles to 29 inpatient bundles. These include 10 orthopedic bundles and eight cardiovascular bundles, and a new liver bundle. CMS also announced three outpatient bundles: Cardiac Defibrillator; Back & Neck, except Spinal Fusion; and Percutaneous Coronary Intervention (PCI).

Additionally, in BPCI Advanced, CMS is focusing on physicians, as opposed to hospitals and other providers, as Episode Initiators. In results from the original BPCI program, physicians, particularly specialists, that “owned the bundle” showed strong performance in cost reduction and quality improvement.

Financial incentives have also been updated, with CMS capping potential loss at 20% of providers’ program size. We expect that CMS will release more details on an updated pricing methodology that is meant to be attractive to and inclusive of both highly efficient and less efficient providers.

When is the deadline to apply to the BPCI Advanced program?

There are still more details to come from CMS about BPCI Advanced. Yet, with just a few weeks before open enrollment closes, the important first step providers can take toward BPCI Advanced is to secure their option to participate. To be clear, this is a non-binding application and does not require actual participation in BPCI Advanced; it merely secures your right to do so if you chose. With CMS’ non-binding application, providers can, in effect, “raise their hands” for participation by submitting some basic information to CMS by the March 12 deadline.

What are the benefits of applying to the BPCI Advanced program?

  1. Power to decide: Engaging CMS now gives you the power decide later. Submitting a non-binding application allows you to receive your cost and quality data and target prices to evaluate if the program is right for you. Once open enrollment closes, there will be no other opportunities to participate in BPCI Advanced until 2020.

  2. Revenue to gain: In addition to the automatic bonuses for Advanced APM participation, practices working with Archway Health in the first generation of BPCI generated as much as $3,000 in additional revenue, per episode of care.

  3. Nothing to lose: Keeping your options open for participation in BPCI Advanced does not bind you to participation. It lets CMS know you that you are considering the program. The binding contract is not due until August.

We urge providers to act immediately. Take the first step and secure your option to participate in BPCI Advanced.

Archway Health is proud to partner with Practice Fusion to help providers successfully navigate bundled payments. We have a number of resources we are offering to help you further:

  • Weekly webinars with live Q&A sessions
  • Archway Academy, a free, online bundled payment learning platform
  • One-on-one coaching, training and support

Contact us at info@archwayha.com for help with BPCI Advanced.