New Voluntary Bundled Payments Program Eligible For MACRA Bonus Pay

Because the BCPI Advanced program qualifies as an advanced APM, participants could have access to MACRA’s potential risks and added rewards.

The CMS Innovation Center launched a new voluntary bundled payment model this week, continuing the Trump administration’s purge of mandatory programs from the Obama era.

Although some experts worry optional models could be less effective, proponents say the new program builds on a proven foundation and will help to reorient the market away from a fee-for-service arrangement and toward a truly value-based system.

“Under this model, providers will have an incentive to deliver efficient, high-quality care,” CMS Administrator Seema Verma said in a statement, noting that this marks the administration’s first advanced alternative payment model (APM).

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The Bundled Payments for Care Improvement Advanced (BPCI Advanced) program is an episode payment model authorized by the Affordable Care Act. Because this new iteration of the current BPCI program qualifies as an advanced APM, participants could be eligible for bonus payments under the Medicare Access and CHIP Reauthorization Act (MACRA).

Avalere Health Vice President Fred Bentley said in a statement that this advanced APM status “creates a powerful incentive for physicians to venture into episodic bundling.” Others who, like Avalere, have been involved in the current version of the program agree.

Carter Paine, MBA, chief operating officer for Nashville-based naviHealth, says the new and improved program is poised to flourish.

“There’s a real blueprint for success now in BPCI, so I think you’re going to see large-scale participation in this voluntary program,” Paine tells HealthLeaders Media.

“From our perspective as a convener, we realized over time who the constituents are within the healthcare ecosystem that we need to influence,” Paine adds. “We figured out where there are, I’d say, pricing or utilization anomalies that we can go affect or intervene on.”

There are 32 clinical episode types in the program. Healthcare organizations that choose to participate will be expected to keep their Medicare costs down while maintaining or improving on quality metrics.

Ashley Thompson, senior vice president for public policy analysis and development for the American Hospital Association, said in a statement that the organization is pleased with the advanced APM status.

"These new models will facilitate hospital-clinician partnerships to provide patients with better, more efficient care," Thompson said. "Additionally, it gives providers new options and opportunities to utilize their investments in moving towards value-based care."

Applications are due by 11:59 p.m. Eastern Standard Time on March 12. They must be submitted via the online application portal. The performance period will begin October 1 and run through 2023.

A second application opportunity is planned for January 2020.

Organizations that make the most of BCPI improve more than just their finances, Paine says.

“It leads to more efficient and better quality delivery for the patients that you manage and come through the doors of your hospital,” he says. “So not only is there a financial opportunity to participate in this program, but there’s a better patient care opportunity—which, from a marketing perspective, I think obviously drives more patients back to your own hospital.”