CMS Announces BPCI Advanced for Hospitals and Physicians- Submissions Due March 12th

CMS has announced the long awaited BPCI Advanced, modeled for hospital and physician participation.  The 2.0 version of BPCI, Advanced builds on outcomes of the Models 1-4 BPCI Pilot concluding Q3 2018.

Quick synopsis:

  • CMS applications are accepted January 11-March 12, 2018.
  • BPCI Advanced is an Advanced Alternative Payment Model (APM) under the Quality Payment Program.
  • A voluntary model, BPCI Advanced can coexist in CJR or other CMS Pilot locations.
  • It includes options for 29 inpatient episodes (105 different DRGs)
  • New inclusions are 3 outpatient episodes (30 HCPCS codes)
  • It’s a retrospective model.
  • Target prices are based on participant historic costs- based on a 4 year baseline (2013-2016) with a rolling 3-year baseline every performance year going forward, updated annually.
  • Reconciliation will occur every 6 months.
  • There are 7 quality performance measures, with adjustments to results.
  • A 5 year Pilot; BPCI Advanced runs October 1, 2018 to December 31, 2023.
  • A 2nd application period is set for January 1, 2020.
  • Interested applicants must file with CMS by March 12th for inclusion.
  • CMS will then provide claims data and target prices for decision making specific to inclusion and choice of episodes.

What are the opportunities?

File by March 12thAccess Innovations prior BPCI Pilot filing yielded extraordinary insights via Medicare claims data, not easily available to providers. We were able to assess opportunities with our prospective participants, identify risk and dialogue with about strategic market relevance for proceeding in the Pilot.  Reviewing your data is a smart first step for all providers interested in care and payment redesign opportunities.  Analysis and consultation fees are nominal.  The opportunity to review and understand your specific claims data is invaluable.

Look closely at Post-Acute Spend:  Access Innovations has historic expertise in Post-Acute Spend where most acute care providers are least focused.  Our model builds on PAC/acute aligned evidence based practices, uses progressive PHI protected IT for care coordination at home and engages on deep Post-Acute culture change.

Engage Like-Minded Providers as Care Partners: Care coordination works when alignments around shared care delivery goals exist.  Access Innovations expertise in identifying high performing Post Acute Care providers will help drive care alignments that will work.

For more information on BPCI Advanced, contact Bryce Henson, or at 614-345-5001 x 208.