CMS Introduces New Bundled Payment Model

The Centers for Medicare & Medicaid Services (CMS) on Tuesday introduced a new alternative payment model, the Bundled Payments for Care Improvement Advanced (BPCI Advanced). Home health services would be eligible to be reimbursed under this program.

The model, coming out of the Center for Medicare and Medicaid Innovation, is a voluntary bundled payment program that enables participants to earn additional payments for a beneficiary’s episode of care if quality is maintained while the cost comes in under a spending target.

Participants in the model can receive payments for 32 clinical episodes of care, including major joint replacement and a coronary intervention, according to CMS’ announcement. BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM), in which providers take on risk to earn the payment incentives.


“CMS is proud to announce this Administration’s first Advanced APM,” CMS Administrator Seema Verma said in a statement on Tuesday. “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 towards paying for value. Under this model, providers will have an incentive to deliver efficient, high-quality care.”

The clinical episodes of care in the BPCI Advanced model include additional outpatient episodes. There are only inpatient episodes in the CMS Innovation Center’s previous bundled payment model—the Bundled Payments for Care Improvement.

CMS is looking for participants to take part in the model, which will start October 1, 2018, and run throught December 31, 2023.


New bundled payment models, which have tied performance and quality to payments for participants were not unexpected; BPCI Advanced, or BPCI 2.0, has been expected since mid-2017. CMS has sought feedback on its previous models to help build on new alternative payment initiatives.

Bundled payment models such as the Comprehensive Care for Joint Replacement (CJR) have been seen as opportunities for home health, which can help keep costs down for episodes of care while driving quality outcomes.

The Trump administration’s first Health and Human Services Secretary, Tom Price, was a vocal opponent of mandatory bundled payment programs, and the agency has backed off on requiring participation.

Written by Amy Baxter

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