9 Key Facts about BPCI Advanced

Posted by Signature Care Management Team on Wednesday, January 10, 2018 in Blog

The Center for Medicare and Medicaid Innovation released the Bundled Payments for Care Improvement (BPCI) Advanced Request for Applications on Tuesday January 9, 2018. The initiative aims to build upon previous bundled payment programs and improve the quality of patient care for Medicare beneficiaries while reducing healthcare costs. Program highlights are below.

  1. BPCI Advanced Model
  • Voluntary retrospective bundled payment model extending 90 days following surgical discharge
  • Medicare payments through the usual fee-for-service model are retrospectively reconciled with total episode costs against a prospective target price
  • Qualifies as an Advanced APM under MACRA

  1. Who Can Participate
  • An Episode Initiator can be an Acute Care Hospital or a Physician Group Practice (post-acute care providers are not currently listed as possible Episode Initiators)
  • Current and past participants of the current BPCI initiative as well as other CMS innovation Center models and Medicare demonstrations are eligible to participate
  • CJR Participants will not be permitted to participate in BPCI Advanced for the same episodes

  1. Timeline
  • March 12, 2018 – deadline for applications to participate in BPCI Advanced
  • August 2018 – final participation agreement and clinical episode selections due
  • October 1, 2018 – BPCI Advanced initiative begins
  • January 1, 2020 – subsequent start date
  • December 31, 2023 – BPCI Advanced performance period ends
  • No clinical episodes or episode initiators can be added or removed between October 1, 2018 and January 1, 2020

  1. Clinical Episodes
  • BPCI Advanced will initially include 29 Inpatient Clinical Episode and three Outpatient Clinical Episodes (see Appendix 1)
  • CMS may elect to revise the list of clinical episodes annually, beginning January 1, 2020.


  1. Target Price
  • A preliminary target price will be determined prospectively and finalized retrospectively for each performance period
  • The historical baseline period, anticipated to include 2014-2016 data, will be used to calculate the target price


  1. Reconciliation
  • Reconciliation will occur semi-annually
  • Quality measures, determined by CMS, will be used to adjust reconciliation payments

  1. Advanced APM
  • Under BPCI Advanced, providers will begin to qualify for the Advanced APM payment track in MACRA year 3

  1. Anticipated Waivers
  • Fraud and abuse waivers
  • Conditional Payment Policy Waivers include the 3-day SNF Rule, Telehealth, and Post-Discharge Home Visit Services

  1. Learning System Activities
  • CMS will require Participants to engage in Learning System Activities that support and provide education regarding care redesign

  With our demonstrated success in the first BPCI initiative, Signature Care Management has the tools and services to help organizations succeed in bundled payments. With only 2 months to apply for BPCI Advanced, there is no time to delay preparations. For more information about BPCI Advanced and to discuss your opportunities, contact us at SCMinfo@signaturehealth.net.   Appendix 1 Inpatient Clinical Episodes  

  • Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis
  • Acute myocardial infarction
  • Back & neck except spinal fusion
  • Cardiac arrhythmia
  • Cardiac defibrillator
  • Cardiac valve
  • Cellulitis
  • Cervical spinal fusion
  • COPD, bronchitis, asthma
  • Combined anterior posterior spinal fusion
  • Congestive heart failure
  • Coronary artery bypass graft
  • Double joint replacement of the lower extremity
  • Fractures of the femur and hip or pelvis
  • Gastrointestinal hemorrhage
  • Gastrointestinal obstruction
  • Hip & femur procedures except major joint
  • Lower extremity/humerus procedure except hip, foot, femur
  • Major bowel procedure
  • Major joint replacement of the lower extremity
  • Major joint replacement of the upper extremity
  • Pacemaker
  • Percutaneous coronary intervention
  • Renal failure
  • Sepsis
  • Simple pneumonia and respiratory infections
  • Spinal fusion (non-cervical)
  • Stroke
  • Urinary tract infection

  Outpatient Clinical Episodes  

  • Percutaneous Coronary Intervention (PCI)
  • Cardiac Defibrillator
  • Back & Neck except Spinal Fusion


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