BPCI Advanced Model – Deadline Fast Approaching

The final phase of CMS’ voluntary Bundled Payments for Care Improvement Advanced (BPCI-A) application process is finally here. Whether your hospital or physician practice intends to participate in the model beginning October 1 (or in a future year) or you are a healthcare attorney advising an organization that intends to participate, CMS’ recent announcements regarding the model are noteworthy.

CMS Offers No-Risk Trial Period

Healthcare leaders and their attorneys have no time to lose in reviewing and completing the BPCI-A model Participation Agreement and Participant Profile, due to CMS no later than 11:59 p.m. EDT on August 8.

This leaves participants less than a month to finish analyzing data supplied by CMS to choose the Clinical Episodes in which they intend to participate and, for Convener Participants, the providers who will be their Episode Initiators. However, CMS relieved some of this pressure when it announced that it is allowing all participants a one-time opportunity to retroactively withdraw Clinical Episodes and Episode Initiators in March 2019.

There’s no catch here. CMS will distribute Participant Profiles in February to allow participants to identify the Clinical Episodes and Episode Initiators they want to retroactively withdraw from participation for 2018 and 2019, and the slate will be wiped clean.

By offering what amounts to a risk-free trial period, the agency enables healthcare organizations to enter the model, initiate their care redesign processes, and obtain several months of actual claims data and updated preliminary Target Prices before deciding whether it makes sense to withdraw. We encourage healthcare organizations that entered the application process in March to choose at least one Clinical Episode and get their feet wet with this value-based payment model while gaining access to valuable claims data.

Fraud and Abuse Waivers Level Playing Field

Healthcare attorneys could be heard breathing a collective sigh of relief on July 3 when CMS released four waivers to shield BPCI-A participants from the Stark Law, the Federal anti-kickback statute and the Civil Monetary Penalties Law. The waivers include:

  • Internal Cost Savings Contribution Waiver
  • NPRA Shared Payment and Shared Repayment Amount Waiver
  • Partner Distribution Payment and Shared Repayment Amount Waiver
  • Waiver for Beneficiary Engagement Incentives Provided to BPCI Advanced Beneficiaries (BEI Waiver)

For hospitals and physician practices that might otherwise run afoul of these laws due to their referral relationships, these waivers add flexibility and level the playing field with all types of Convener Participants.

Start Using Data to Redesign Care Processes

CMS extended additional relief to applicants by pushing the deadline to submit the Care Redesign Plan, Financial Arrangement List and list of participating Physician Group Practice Practitioners to September 14.

However, don’t wait to tackle these important deliverables. Start moving on care improvement plans as soon as you’ve selected your Clinical Episodes and Episode Initiators. Redesigning processes and building infrastructure to reduce variations in care will require significant input from clinical and administrative leaders, so we recommend assembling a team to analyze cost and quality data and brainstorm ways to reduce clinical variation and win at the bundled payment game.

Even if your organization decides not to join BPCI-A this year, make full use of the data at your disposal. Start benchmarking your organization’s costs to identify variations and engage physicians and post-acute care providers in efforts to reduce those variations. If you haven’t yet applied, consider applying in 2019 for the Second Cohort beginning in 2020. The data provided to Applicants is valuable in addressing care redesign, whether or not your organization participates in BPCI.

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Topics: Bundled Care, BPCI-A

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