Ensocare Deep Dive Series: Part I - What is BPCI Advanced?

by Ensocare on Mar 1, 2018

What is BPCI Advanced?

In Part I of this four-part series, Justine Olsen, Healthcare Strategy Analyst, explains BPCI Advanced, the Bundled Payments for Care Improvement program. Learn the key differences between this and the earlier iteration of the alternative payment model and what it might mean for your organization.

Watch Part II: Recapping a Year of Change
Review 2017 initiatives that affected the bundled payment programs leading up to the new BPCI Advanced model.



I’m Justine Olsen and I’m a Healthcare Strategy Analyst.

BPCI Advanced is a brand new initiative from CMS’s innovation center, the CMMI. And so it’s an alternative payment model structured as a bundled payment. It’s really the second iteration of the BPCI program, which has been a very popular bundled payment program that has existed for several years. The original BPCI program is being phased out in September of 2018 and, as we transition into this next iteration, BPCI Advanced is also an episode of care-based model that really does build upon lessons learned in the original iteration.

I would say the biggest difference for BPCI Advanced is that providers participating in the program will assume risk from day one of program participation. They really don’t have a ramp-up period to get used to participation in the program. Once they elect to participate, they are responsible for managing the total cost of care as well as the quality of care for the clinical episode that they’ve selected. And if they exceed cost thresholds or targets that have been established by CMS, they’ll be responsible for reimbursing CMS for going over essentially that target. That’s one of the biggest differences.

Another exciting difference related to BPCI Advanced is that it actually meets the qualification as an Advanced APM, an Alternative Payment Model. That relates to MACRA, or the Quality Payment Program. Essentially what that means is that providers participating in BPCI Advanced do have the potential to be exempt from that MIPS program and in addition to that are eligible to receive that 5% bonus that comes from participating in an advanced APM.

Why this is particularly important for specialists is that there are a certain number of specialists, more hospital-based, so your hospitalists or surgeons, who historically have had limited ability to participate in other advanced alternative payment models just based on the design of those. They’ve primarily been more primary care-focused, and so this designation as an advanced alternative payment model for an episode of care program provides an opportunity for them to participate in their own right. That’s an exciting opportunity for providers to consider.

And then finally, another component that’s interesting about BPCI Advanced is that it does include outpatient episodes of care. This is really the first bundled payment opportunity that goes beyond inpatient and extends some clinical episodes into the outpatient setting. Why that’s important is it really does indicate CMS’s recognition of an industry-wide shift so, looking at issues like cost containment, we know that there’s really a shift from procedures being completed on an inpatient basis towards a focus on that outpatient setting. This program does well to indicate that that shift is continuing.

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