Avalere: Despite dropouts, BPCI Advanced participation shows providers open to greater risk 

A dollar sign created by Monopoly game houses is surrounded by Monopoly money. Dice and the car token appear next to the dollar sign as well.
A new report looks at enrollment trends in the Bundled Payments for Care Improvement Advanced model. (Getty Images/martince2)

Though a number of providers have dropped out of the Centers for Medicare & Medicaid Services' new voluntary bundled payment program, there are signs participants are getting used to the idea of greater risk. 

A new report from Avalere found that participation in the Bundled Payments for Care Improvement (BPCI) Advanced model dropped by 16% between Oct. 1 and March 1, when providers were required to take on greater risk.  

But there are still about 1,300 providers in the program—715 hospitals and 580 physician groups, according to the report. 

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Gabriel Sullivan, a manager at Avalere and one of the report’s authors, told FierceHealthcare that because the model is voluntary this level of participation is impressive even with some providers getting scared off. 

“That there is still robust participation in this program, a risk-based model that’s voluntary in nature, it suggests that providers are increasingly feeling comfortable and ready to assume that risk,” he said. 

RELATED: Progress on the adoption of risk-based financial models has stalled, survey finds 

By comparison, 26% of providers dropped out of the original BPCI program, which was launched under the Obama administration, when pushed to take on greater financial risk, Sullivan said. 

When BPCI Advanced launched, more than 1,500 providers signed up. Avalere points to several factors that led some to exit the model early. For one, ahead of the model’s risk-bearing phase, providers were given historical data on all conditions in the program, which would have led them to participate for more conditions than they would have with greater risk. 

In addition, applications for the model required a tight turnaround, so providers may not have had the time to fully analyze which conditions they’d best be able to participate with. 

“BPCI Advanced had a relatively tight time frame compared to other alternative payment models,” Sullivan said. “Providers likely did not have enough time to really roll up their sleeves and make those strategic considerations and decisions.” 

BPCI Advanced was the first new payment model launched by CMS under President Donald Trump and includes 32 clinical care episodes, 29 of which are inpatient. 

Shortly before the model’s release in January 2018, CMS canceled two mandatory bundles that were planned by previous administration. Former Department of Health and Human Services Secretary Tom Price was a sharp critic of mandatory bundles, saying as a representative that the agency overstepped its authority in requiring such payments. 

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