The impact of CMS’ new voluntary bundled-payment model for independent physicians February 1, 2018
The Centers for Medicare & Medicaid Services (CMS) has announced a new incentive for independent physicians, called the Bundled Payments for Care Improvement Advanced (BPCI Advanced). The announcement comes as many independent physicians are being challenged by the reporting requirements and regulations involved in the CMS shift to value-based services during which CMS is encouraging physicians to move away from the fee-for-service model.
When making the announcement, CMS Administrator Seema Verma stated that “BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value. Under this model, providers will have an incentive to deliver efficient, high-quality care.”
CMS previously implemented the Quality Payment Program (QPP) as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under the QPP, independent physicians have the option between two payment models: Advanced Alternative Payment models (APMs) or the Merit-based Incentive Payment System (MIPS).
CMS’s announcement emphasized that “under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.” According to CMS, additional impacts for independent physicians include:
- BPCI Advanced participants may receive payments for performance on 32 different clinical episodes
- BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program.
The announcement continued that “BPCI Advanced seeks to support and encourage participants who are interested in:
- Continuously redesigning and improving care
- Decreasing costs by eliminating care that is unnecessary or provides little benefit to patients
- Encouraging care coordination and fostering quality improvement
- Participating in a payment model that tests extended financial accountability for the outcomes of improved quality and reduced spending
- Creating environments that stimulate rapid development of new evidence-based knowledge
- Increasing the likelihood of better health at lower cost through patient engagement, education, and on-going communication between doctors and patients.”
The BPCI Advanced model performance period runs from October 1, 2018, through December 31, 2023. Independent physicians interested in more information or in applying for the program should visit the BPCI Advanced website.