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BPCI Advanced: What Hospitals and Physicians Need to Know

Summary

With applications for the new Bundled Payment for Care Improvement (BPCI) Advanced initiative due on March 12, providers have a short window to act.

In a shift from previous BPCI initiatives, BPCI Advanced includes opportunities for bundles in outpatient settings. The Centers for Medicare & Medicaid Services (CMS) may be looking to expand episodic based payments in the outpatient setting down the road, making BPCI Advanced an opportunity to gain early experience with bundled payments in this setting.

Hospital executives and physicians need to take the following steps before March 12:

1. Download the application.

Organizations seeking to join BPCI Advanced either as a non-convener participant (acute care hospitals (ACHs) or physician group practices (PGPs) that accept financial risk only for their organization) or a convener (other providers or suppliers that accept financial risk for multiple organizations) must submit the application through the Center for Medicare & Medicaid Innovation’s web-based portal by March 12. The initial application includes sections on quality assurance, beneficiary protections, organizational readiness and partnerships, and practitioner engagement and care improvement

2. Know the timeline.

Entities must submit applications by the March deadline, but they are not binding. By May, CMS plans to distribute target prices for the episodes of care and participation applications. If they choose to participate, applicants will have until August to return the signed agreement to CMS.

3. Quantify your opportunities.

Given that CMS requires all applicants take on risk, organizations should identify high-performing facilities and determine the conditions for participation based on historical and regional performance.

While post-acute care (PAC) providers are not eligible to be non-conveners in BPCI Advanced, there are still opportunities to participate. PAC providers can engage in gainsharing as partners with PGPs and ACHs or apply to be a convener. PAC providers should identify which BPCI Advanced participants they would be willing to partner with.

4. Align your stakeholders.

Because BPCI Advanced can be tailored to fit your organization, you need to bring together all stakeholders before August to identify the opportunities that are right for your organization. It is important to gauge interest with potential partners – including convener applicants or organizations for which you might act as a convener. Both convener and non-convener applicants should identify and engage with potential gainsharing partners and align with downstream entities, participating practitioners, and episode initiators to prepare for model implementation.

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