CMS unveils new voluntary bundled payment program 

The new model is the first launched by CMS under the Trump administration. (

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. 


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

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. 

RELATED: 3 key elements for the next generation of bundled payments 

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.

RELATED: Hospital Impact―5 healthcare delivery trends to watch in 2018

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. 

Suggested Articles

Two lawsuits were filed suing the Trump administration to overturn a new rule that would allow healthcare workers to deny care over religious or conscience…

Policy changes are affecting how investors view the skilled home health market and paving the way for potential strategic acquisitions.

JLABS executive Kate Merton talks about the JLABS model and Johnson & Johnson’s interest in digital health.