The Next Generation of BPCI: What We Know So Far

The next generation of Bundled Payments for Care Improvement (BPCI) is on its way. Though an official release date remains to be seen, the Centers for Medicare & Medicaid Services (CMS) does expect to announce the new model before the end of the summer. As we await the details of the coming voluntary model, results from the first generation of the BPCI program provide us clues into what the new program might look like. BPCI Success  

The original BPCI program will end in September 2018. Currently, there are 1,191 participants in BPCI Models 2 - 4, according to the Bundled Payments for Care Episode Analytic file updated April 6, 2017; an additional 38 Awardees participated in BPCI Model 1 which concluded on March 31, 2016. The episode groups with the greatest participation under BPCI are lower joint replacements, sepsis, congestive heart failure, and pneumonia and other infections. Orthopedic specialists participating in these episodes have realized on average $864 in savings per clinical episode.

Though these savings are significant, the anecdotal information that CMS has gathered indicates that many providers have saved even more. Taking a look at our own slate of specialists, Archway has helped them earn more than $2,000 in additional revenue per case.

The Next Generation  

Without a doubt, CMS’ new BPCI program will build on the success of the original program. Logistically speaking, CMS has confirmed that it will continue to offer a voluntary bundled payment program that qualifies as an Advanced Alternative Payment Model (APM) under MACRA’s Quality Payment Program.

Additionally, the next generation of BPCI is being designed by both an internal CMS team and participating healthcare providers. CMS has conducted many interviews with current BPCI participants to gain insight for fine-tuning the next iteration. Providers have expressed they would like to see:

  • More inclusive pricing model: Providers want to see a modified pricing model that creates opportunities for both highly efficient and less efficient providers.
  • Championing specialists: This round of BPCI will place more emphasis on specialty physicians as episode initiators.
  • Changes in how the trend factor is applied: Providers expressed concern with the current methodology of how CMS adjusts target prices for BPCI participants each quarter.
  • Better-assigned National Provider Identifiers (NPI): CMS has had challenges accurately attributing patients to participant physician groups, particularly hospitalists.
  • Managing risk upstream: Rather than only working with third-party conveners or becoming conveners themselves, providers would like to work with payers and re-insurance companies to help manage risk.

Given the new BPCI model will be a voluntary model like its predecessor, we expect these matters will be addressed in the coming BPCI program so as to entice participation.

The Timeline

While the exact release date of the new BPCI model is not known, CMS does expect an announcement soon. This coincides with a BPCI report expected to be released on how the program has done so far, including stratifying by specific clinical episodes, not just episode groups.

Though the last BPCI was not officially rolled out until three years after its announcement in 2011, we also expect that the next generation will go live in mid 2018 to to coincide with the sunsetting of the BPCI program in September.  This is important for two reasons: it enables participating providers to continue in the program, and it creates an opportunity for specialists to qualify for the Advanced APM payment track in Year 2 MACRA and avoid the more punitive MIPS track.

 In the Meantime 

Though the new BPCI model has not yet been announced, providers, particularly specialists, should consider preparing for participation in this new bundled payment model. At Archway, bundled payments are all we do, and we are committed to helping healthcare providers succeed in the next generation of BPCI.

In a free, half-hour consultation, we can help healthcare providers, and specialists in particular, learn more about the imminent BPCI program, and find potential savings in a provider-specific Bundled Payment Scorecard. To learn more, we welcome you to contact our team at info@archwayha.com.