CMS Announces New Payment Model
CMS has announced a new payment model that will improve the quality, coordination, and cost-effectiveness for both inpatient and outpatient care.
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform, but under this new bundled payment model, participants have the opportunity to earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.
Bundled payments create incentives for providers and practitioners to work together to coordinate care and engage in continuous improvement to keep spending under a target amount. BPCI Advanced Participants may receive payments for performance on 32 different clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient).
CMS designed this model taking into account rigorous evaluation results from previous CMMI models, industry experience with bundled payment, and stakeholder input from healthcare providers at acute care hospitals, physician group practices, and other providers and suppliers. BPCI Advanced seeks to support and encourage participants who are interested in:
• continuously redesigning and improving care,
• decreasing costs by eliminating care that is unnecessary or provides little benefit to patients,
• encouraging care coordination, and fostering quality improvement,
• participating in a payment model that tests extended financial accountability for the outcomes of improved quality and reduced spending,
• creating environments that stimulate rapid development of new evidence-based knowledge, and
• increasing the likelihood of better health at lower cost through patient engagement, education, and on-going communication between doctors and patients.
The Model Performance Period for BPCI Advanced starts on October 1, 2018 and runs through December 31, 2023. Like all models tested by CMS, there will be a formal, independent evaluation to assess the quality of care and changes in spending under the model.
For more information about the model and its requirements, or to download a Request for Applications document (RFA), the application template, and the necessary attachments, please click here. Applications must be submitted via the Application Portal, which will close on 11:59 pm EST on March 12, 2018. Applications submitted via email will not be accepted.