BPCI Advanced: What You Need to Know and Actions You Need to Take

January 15, 2018

BPCI Advanced: What You Need to Know and Actions You Need to Take

by | Jan 15, 2018 | Grow Article |

Navvis Grow Article By: Sheila Fusé, Navvis Senior Vice President Policy & Payment and Tyler Oleksy, Navvis Director of Analytics 


On January 9, 2018, the Centers for Medicare & Medicaid Services (CMS) released the long-expected voluntary Bundled Payments for Care Improvement Advanced (BPCI Advanced) program. The program closely resembles the bundled payment models that preceded it, combining some of the more popular elements from both voluntary and mandatory programs. 

The program’s aim is to align incentives among participating healthcare providers for reducing expenditures and improving quality of care for Medicare beneficiaries. Acute care hospitals and physician group practices have an opportunity to receive gainsharing payments when they successfully coordinate care during an episode.

The following provides a short summary of the key points and critical next steps for all healthcare organizations. Please click on the following link for a PDF summary of our insights and recommended action steps: Navvis BPCI Summary and Action Steps

BPCI Advanced: Key Points

  • The application window runs from January 11 to March 12, 2018.
  • BPCI Advanced will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.
  • Claims data and target prices will be provided after the initial application is submitted.
  • This is a voluntary model. Participants will choose from the model’s 32 different potential episode options:
    • 29 inpatient episodes defined by 105 different Medicare Severity-Diagnosis Related Groups
    • 3 outpatient episode options based on 30 specified HCPCS codes
  • BPCI Advanced will be a retrospective payment model, and target prices will only be based on participants’ historical costs.
  • CMS is indicating prices will be based on a four-year baseline to start (2013-2016), then a rolling three-year baseline every performance year thereafter, updated annually. Reconciliation will occur every six months.
  • Results are subject to adjustment based on provider performance relative to seven quality performance measures.
  • The program runs from October 1, 2018 and continues until December 31, 2023. Providers will have the option to enroll in a second application period planned for January 1, 2020.

Navvis’ Recommended Action Steps 

  1. Request your data. This doesn’t obligate you to participate in the new BPCIA program. However, your data is foundational to helping you assess your opportunities and risks for participating. CMS will provide this at no cost. Alternatively, request your data from a strategic advisory partner who may be able to provide the data more quickly for a nominal fee.
  2. Evaluate opportunities and risks. Take a look at your high-volumes episodes, where your historic spend is above average, and your rate of readmissions.
  3. Consider more proactive management of post-acute spend. The area of greatest variability across many episodes is post-acute spend. It is also the area least pro-actively managed by many health systems. Look at your discharge planning process. Look at referral rates for your owned post-acute assets. Consider establishing an aligned post-acute care network that is actively managed.
  4. Establish a plan to coordinate care post-discharge. How the actual care post-discharged is managed and coordinated is another key opportunity area? What mechanisms are in place to continue to monitor your episode participants after they leave the hospital?
  5. Create strategic buy-in and alignment. Create a process and a structure that incents organizational buy-in from other stakeholders. Having physicians be a part of your bundled payment program is foundational to success.