CMS unveils new voluntary bundled payment program 

CMS announced the launch of a new bundled payment model on Tuesday, less than two months after it canceled two mandatory bundled payment programs created under the Obama administration. 

The Bundled Payments for Care Improvement (BPCI) Advanced model is the first advanced payment model launched by the Centers for Medicare & Medicaid Services under the Trump administration, and includes 32 clinical care episodes for participating providers to choose from, according to an announcement from CMS. 

Twenty-nine of the care episodes included in the model are inpatient, while the remaining three are outpatient, according to CMS. Care episodes in the model include major joint replacement, spinal fusion and both inpatient and outpatient percutaneous coronary intervention. 

Administrator Seema Verma said in the announcement that the BPCI Advanced model will give providers "an incentive to deliver efficient, high-quality care." 

"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 toward paying for value," Verma said. 

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The new bundled payment model's reveal comes shortly after CMS decided at the end of November to cancel two mandatory bundled payment programs formed by the CMS Innovation Center under the previous administration. The programs, which targeted cardiac and joint replacement care episodes, were set to go into effect on Jan. 1. 

CMS' new model is voluntary, and the model performance period will begin on Oct. 1 and run through the end of December 2023. Applications for BCPI Advanced will be accepted through mid-March, CMS announced. 

Voluntary payment models like BPCI Advanced may run into problems with retention, however, that could limit their effectiveness, according to a new study. Researchers examined participation data on the BPCI initiative, which was launched in 2013, focusing on track two that included the vast majority (99%) of participating providers.

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The study found that just 12% of eligible hospitals joined the program. Nearly half (47%) later dropped out of the program, according to data published in the Journal of the American Medical Association.

Mandatory bundled payment programs later formed by Medicare were criticized for putting undue burden on clinicians, but may have been more effective due to greater participation, the researchers said. 

"Patterns of participation and dropout in the BPCI program suggest that for voluntary alternative payment models to have a broad effect on quality and costs of health care, barriers to participation and strategies for retention need to be addressed," they concluded.