January 2018

New BPCI Program Includes Lower-Extremity Episodes

By Laura Hochnadel

The US Centers for Medicare & Medicaid Services (CMS) recently announced a new voluntary bundled payments opportunity, known as the Bundled Payments for Care Improvement Advanced (BPCI Advanced), which will be launched in October 2018 and run through 2023. The program builds on the existing BPCI initiative and, notably, adds three outpatient episodes to the inpatient care episodes included in the original BPCI demonstration. Providers can elect to receive bundled payments for 32 clinical episodes, of which five pertain to the lower extremity: double joint replacement of the lower extremity; fractures of the femur and hip or pelvis; hip and femur procedures except major joint; lower extremity/humerus procedure (except hip, foot, and femur); and major joint replacement of the lower extremity.

Providers who join the bundled payments model will have to repay CMS for financial losses incurred during qualifying 90-day care episodes, but they can also share in the savings if actual care costs are below the spending target. Providers can earn additional payments under the model by demonstrating high-quality performance as long as actual costs do not exceed the spending target. Participating providers are required to use certified electronic health records (EHR) technology.

More information: https://innovation.cms.gov/initiatives/bpci-advanced.

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