Sample Solution

The Centers for Medicare and Medicaid Services (CMS) developed the Bundled Payments for Care Improvement (BPCI) Advanced model to test bundled payments for 32 specific episodes and to incentivize participating providers for decreasing care costs and improving care quality for Medicare patients receiving care for one of these 32 clinical episodes.1 This model is entirely voluntary, consists of a single retrospective bundled payment with a 90-day clinical episode 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 mo