CMS Bundled Payments for Care Improvement – Advanced (BPCI – Advanced)

What is BPCI – Advanced?

BPCI-Advanced began on October 1, 2018 and will run its entirety, through December 31st, 2023. This is a voluntary, single risk track, bundled payment program that incentivizes hospitals and physicians to work together to improve quality and costs for any of the selected 31 Inpatient clinical episodes and or 4 Outpatient clinical episodes or “bundles.”

The "bundle" includes the acute care episode or procedure and the 90-day post-acute period. The hospital takes responsibility for coordinating the care and has financial risk for the quality and cost of care. If financial performance is better that the CMS targets, hospitals may receive additional payments from CMS; if not, hospitals will owe money to CMS.

If successful, the model will result in streamlined, coordinated care episodes that improve quality and the patient experience and reduce costs (defined as what Medicare pays for services). As both commercial and government payors transition away from paying for volume and move toward paying for value, experience with value-driven care, such as bundled payments, will become ever more essential.

Why are Tower Health hospitals participating?

Tower Health maintains its commitment to being innovative with a focus on alternative payment models, such as bundled payments. Several hospitals, including Brandywine, Phoenixville, and Pottstown, previously participated in a similar bundled payment model with CMS and successfully demonstrated their ability to achieve savings while maintaining quality of care over a five-year period between 2013 and 2018. In 2016, Reading Hospital began participating in Comprehensive Care for Joint Replacement (CJR), a mandatory Medicare bundled payment program focused on total joint replacement. Reading's success under CJR encouraged Tower Health to pursue a broader system-wide bundled payment strategy. This strategy now encompasses CJR, commercial bundles, and BPCI-Advanced.

Learn about the latest updates, including current participation, program details, and what's new for 2021 in the BPCI-A program overview for physicians.

Value-Based Care post COVID-19 

Congress established The Center for Medicare and Medicaid Innovation (CMMI), a decade ago. The central focus of this establishment is to promote value through the testing of alternative payment models. Current alternative payment models consist of episode-based payment initiatives (like BPCI-A), primary care transformation models, accountable care-based programs and more. There is no doubt that COVID-19 has had a deep impact and has changed the landscape for how healthcare is and should be delivered to patient populations.

In light of the COVID-19 pandemic, the ways in which most healthcare systems manage both routine & complex acute care as well as promote wellness with a population health-focus has shifted dramatically over the last year. Within the healthcare markets, COVID-19 has solidified the urgency to shift traditional fee for service payments to payments which more intently reward value for services provided.

A blog posted recently by ECG Management Consultants, discusses the acceleration toward value in the post COVID-19 environment. It is more important than ever that when the opportunity arises, Tower Health physicians continue to engage in value-based care initiatives as market forces are likely to only continue to grow in size and scope moving into the future.