New Medicare Bundled Payment Model Begins – Pa. Hospitals and Practices Among the Participants

Last Updated: Oct 23, 2018

surgery-doctorsThe Centers for Medicare and Medicaid Services (CMS) launched a new value-based payment model – Bundled Payments for Care Improvement Advanced (BPCI Advanced) – on Oct. 1, 2018. There are 1,547 participants in the nationwide model, including hospitals and physician practices located throughout Pennsylvania.

A participant who spends less than a targeted amount for a beneficiary’s episode of care can earn additional payment. If expenditures exceed the targeted amount, the participant must repay the money to Medicare.

The model does qualify as an Advanced Alternative Payment Model (Advanced APM), which is one of the two performance tracks of MACRA’s Quality Payment Program (QPP). The other performance track of the QPP is the Merit-based Incentive Payment System (MIPS).

Details on the BPCI Advanced Model
Participants in the BPCI Advanced model are required to keep Medicare expenditures within a defined budget while also maintaining or improving performance on specific quality measures. A few key elements of the model are:

  • Physician group practices and acute care hospitals are among the participants.
  • Participants are required to use Certified Electronic Health Record Technology. 
  • The model includes 29 Inpatient Clinical Episodes such as acute myocardial infarction, major joint replacement, and stroke. It also includes three Outpatient Clinical Episodes, including percutaneous coronary intervention.
  • Of the 32 bundled clinical episodes included in the model, the top three episodes selected by participants are major joint replacement of the lower extremity, congestive heart failure, and sepsis.
  • The model offers a single retrospective bundled payment and one risk track, with a 90-day clinical episode duration.
  • Preliminary Target Prices are provided in advance of the first performance period of each model year.

The performance period for BPCI Advanced will continue through Dec. 31, 2023. CMS says it will provide a second opportunity to apply in January 2020.

View the list of BPCI Advanced participants.

Additional Resources
More details about the model – including its clinical episodes and quality measures – are available on CMS’ BPCI Advanced webpage. Questions on the model can be emailed to CMS at BPCIAdvanced@cms.hhs.gov.  

Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.


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