News: BPCI Advanced participation down 16% in the first five months

The number of providers participating in CMS’ Bundled Payments for Care Improvement Advanced (BPCI Advanced) payment model has declined by 16% since the program started five months ago.

CMS announced recently that 1,086 providers are currently participating in the BPCI Advanced model. When the model was rolled out in October, there were 832 acute care hospitals and 715 physician group practices participating, representing a total 1,547 Medicare providers, Modern Healthcare reported. That number has since declined to 715 hospitals and 580 physician group practices for a total of 1,295 providers.

The BPCI Advanced model combines payments to the physician, hospital, and other healthcare provider services. Participants can get an additional payment if all the costs for an episode of care are less than a benchmark price, discounted by 3%. If they exceed the benchmark, the providers would have to repay up to 20% of the excessive costs to Medicare.

The rollout of the model got off to a bumpy start initially because CMS was late providing claims data to providers, which they needed to decide which bundles to select, according to Modern Healthcare. The details were so hazy that the American Hospital Association stepped in to request that CMS delay the application deadline to allow providers to make informed decisions.

In response, CMS gave providers an additional withdrawal option so that participates could opt out of the program without a penalty so they could get a feel for the program before making their final decision. Given the option to leave without penalty, the exodus from the program could be considered modest, according to Modern Healthcare.  

Keeping participants in a voluntary bundled payment model has posed a problem for CMS in the past as well, and according to a recent study from the U.S. Government Accountability Office, because the pool of participants is relatively small, voluntary programs may not be reliable for data analysis.

CMS announced, nonetheless, that they will hold a second enrollment period for the BPCI Advanced model, with more information coming later this spring.

Editor’s note: To read Modern Healthcare’s coverage of this story, click here. To read about the BPCI Advanced model, click here. To read about the AHA’s concerns about the program’s rollout, click here. To read about the GAO study, click here.