What can the industry expect from the BPCI Advanced program?

Written by Megan Wood | November 02, 2017 | Print  |

With the Bundled Payments for Care Improvement initiative coming to an end in the third quarter of 2018, the healthcare industry anticipates the unveiling of a new program.

"A lot of providers are waiting with bated breath to find out what the program is going to look like," says Darcie Hurteau, a director at Rensselaer, N.Y.-based healthcare data analytics and policy firm DataGen.


Since its implementation in 2013, the BCPI program garnered impressive engagement from the industry, notes Ms. Hurteau. The program involves four distinct models, which connect single, fixed payments to numerous related services during a care episode. The first three models reconcile payments retrospectively and the fourth model establishes payments prospectively:


  1. Retrospective acute care hospital stay
  2. Retrospective acute and post-acute care episode
  3. Retrospective post-acute care only
  4. Prospective acute care hospital stay only


At this time, 1,191 participants are currently in BPCI's Models 2, 3 and 4.


Now, it's anyone's best guess as to what the "BPCI Advanced" program will unroll. CMS has not announced the release of the new model, but notes it will be a voluntary bundled payment program that fits the bill for MACRA's Advanced Alternative Payment Model.


Ms. Hurteau offers key predictions that the industry may see with the new program.


Included conditions
Ms. Hurteau says a major point of speculation is what conditions the new program will include. She believes the program will focus on diagnosis-related groups, similar to the models of the traditional bundled payment programs.


"The DRG-based [models] are relatively easy to understand and they're relatively straight-forward," adds Ms. Hurteau.


While BPCI based its targets off of providers' historical experience, the Comprehensive Care for Joint Replacement determines targets based on regional performance. That said, Ms. Hurteau foresees the BPCI Advanced model basing targets off of providers' historical experience.


While Ms. Hurteau believes hospitals will definitely take part in the new program, physician participation is more of a murky area.


"Hospitals have a lot of capital to bear financial risks whereas smaller physician groups don't," she explains. "Aside from the hospital [participation], who knows?"


Gainsharing will likely be a part of the BPCI Advanced program, predicts Ms. Hurteau. This is a program where physician engagement is paramount and CMS will ensure physicians have skin in the game.


"You get much better engagement when you can gainshare with physicians," adds Ms. Hurteau.


Evaluation periods
The BPCI program didn't make an official entrance until three years after CMS announced it in 2011. Due to the high provider engagement in BPCI currently, Ms. Hurteau hopes CMS will jumpstart the next program right on its heels.


"[Providers] want to take those learnings and spread them farther than one practice and one program," Ms. Hurteau says. "If CMS delays too long, I think some of that will wane."


Whether or not providers plan to participate in the BPCI Advanced program, Ms. Hurteau highly recommends all providers ask CMS for data.


"[Providers] should do that to look at their own data and re-evaluate what these programs look like for them," she concludes.


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