de duration, and places more risk onto the providers than previous BPCI models.1
There are seven quality measures for BPCI Advanced, including all-cause hospital readmissions, advance care plan, and CMS patient safety indicators that are used to measure the quality of care and reimbursement level for each episode.1 To identify reimbursement level, CMS compares the aggregate Medicare fee-for-service (FFS) expenditures included in a clinical episode against the episode’s target price to determine whether the participant will either receive a payment or be required to pay CMS. If the provider keeps costs below the target price for each episode, financial savings will be generated through this value-based payment (VBP) model, in addition to the improvement in the quality and continuity of care for Medicare patients. At this time, BPCI Advanced results are not yet available in order to determine the extent of the gains/losses realized in this VBP model.2
Implementation of BPCI Advanced for providers that have used past BPCI models, particularly BPCI Model 3, would be less challenging than for providers who have not, due to preestablished networks and pathways for continuity of care for some clinical episodes as well as familiarity with the program.2 In addition, many providers will be interested in participating, as BPCI Advanced qualifies as an Advanced Alternative Payment Model (APM) and thus exempts participants from payment reductions under MACRA.3 BPCI Advanced is also a voluntary payment model and will see less opposition than mandatory models such as Comprehensive Care for Joint Replacement (CJR) did, but it may not generate the same level of savings as CJR has.3 The greatest challenges with BPCI Advanced will be associated with new outpatient episodes, as previous BPCI models focused solely on inpatient episodes.4 Overall, there is significant opportunity to incentivize providers to decrease costs and improve quality for some of Medicare’s most common and most expensive clinical episodes, but implementation strategies must address challenges in order to optimize the success of this VBP model.
Key lessons learned in implementation from other payment models include the pla