Changes to BPCI Advanced model catch providers off guard

Providers taking part in Medicare’s largest bundled-payment program are wary about changes unveiled Thursday by CMS’ Center for Medicare & Medicaid Innovation.

The agency said it was changing how it sets target prices for the fourth year of its Bundled Payments for Care Improvement Advanced model to reflect decreased care costs and “make BPCI Advanced less susceptible to unpredictable changes in policy, coding and clinical practice for future model years,” according to an email to BPCI Advanced participants. It will also force providers to select clinical episodes by service line instead of individual episodes. The changes are effective January 1.

CMMI announced earlier this year that it would change how it calculated target prices because the model isn’t saving enough money. But some providers are concerned about changes that allow the agency to adjust target prices retrospectively.

“We just don’t know how much they will change, and that can be problematic because how do you know what you’re trying to manage to if you’re going to lower the cost for an episode?” said Aisha Pittman, vice president of policy for consultancy and group purchasing organization Premier Inc.

The changes to how providers choose clinical episodes caught experts off-guard and could be more challenging to deal with than the target price adjustments. Many providers in the model now take part in one or two clinical episodes for a given service line, which often include several clinical episodes. Hospitals may be unprepared to accept bundled payments for an entire service line like cardiac because it could require new investments and infrastructure.

“It’s not always the same care teams that are dealing with those different episodes, so they’re going to have to roll out new interventions,” Pittman said. “That’s very difficult to do, particularly this year (due to COVID-19).”

Providers will get the information they need to decide next month, and CMMI wants them to decide whether to take part in November.

“Now they’re going to have to decide very quickly if they want to do all of the episodes … or drop out for all of the episodes,” Pittman said.

Experts say providers might drop out of the program if they can’t take on a full service line of clinical episodes.

According to a June report from CMMI, more providers are taking part in BPCI Advanced than its predecessor. But the results of the demonstration probably won’t carry over to a larger or different group of providers because participants choose whether and how to participate. The recent wave of changes could be an effort to make the demonstration more useful in preparation for a mandatory model down the line.


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