The Centers for Medicare and Medicaid Services (CMS), through its Innovation Center, released a new voluntary bundled payment model on Jan. 9 called Bundled Payments for Care Improvement Advanced (BPCI Advanced). This model is intended to build on the lessons from the current Bundled Payments for Care Improvement model that will conclude later this year. BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program (QPP) in 2018. Qualified participants (based on either patient counts or payment) are eligible for a five percent bonus in payment years 2019 through 2024. Under the Medicare Access and CHIP Reauthorization Act (MACRA), Advanced APMs must include the use of certified electronic health records, use quality measures similar to those in the Merit-based Incentive Payment System (MIPS) and bear financial risk. 

In BPCI Advanced, 32 distinct clinical episodes are available to model participants. Of those episodes, 29 are inpatient, including AMI, cardiac arrhythmia, cardiac defibrillator, cardiac valve, congestive heart failure, coronary artery bypass grafting, pacemaker and percutaneous coronary intervention (PCI). New to this version of BPCI are three outpatient clinical episodes, including PCI. The first cohort of participants will start on Oct. 1, 2018, with a performance period running through Dec. 31, 2023. CMS will provide a second application opportunity in Jan. 2020. CMS will hold an open door forum on the model on Tuesday, Jan. 30, 2018 from Noon – 1 p.m. ET. The forum will include an overview of the model and application process and a question and answer session. Register in advance.

ACC believes that APMs, such as BPCI Advanced, have the potential to enhance patient care and improve the quality of care while lowering Medicare and Medicaid costs. To support members considering participation in APMs, ACC is creating the Alternative Payment Model Framework, launching in February on ACC.org. This tool will help members assess their readiness for APM participation. ACC also maintains the MACRA Hub for members seeking general information on the QPP, including information on Advanced APMs.

Keywords: Medicaid, Centers for Medicare and Medicaid Services, U.S., Outpatients, Inpatients, Medicare, Health Expenditures, Coronary Artery Bypass, Patient Care, Percutaneous Coronary Intervention, Electronic Health Records, Pacemaker, Artificial, Arrhythmias, Cardiac, Heart Failure, Quality of Health Care, ACC Advocacy

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