CMS Announces New Payment Model to Improve Quality, Coordination, and Cost-Effectiveness for Both Inpatient and Outpatient Care

CMS Press Release (01/09/18)

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation has launched Bundled Payments for Care Improvement Advanced, a new voluntary bundled payment model. Bundled payments create incentives for providers and practitioners to collaborate on giving care and engaging in continuous improvement to keep spending under target amounts. Under the new model, participants may receive payments for performance on 32 different clinical episodes. In addition, BPCI Advanced supports healthcare providers who invest in practice innovation and care redesign to improve quality and reduce expenditures. BPCI Advanced will qualify as an Advanced Alternative Payment Model under the Quality Payment Program (QPP), which was implemented by the 2015 Medicare Access and Chip Reauthorization Act. QPP creates two tracks for physician payment: the Merit-Based Incentive Payments System, under which providers have to report a range of performance metrics and then have their payment amount adjusted based on performance; and the Advanced APM Track, under which providers take on financial risk to earn the payment. Under the BPCI Advanced model, "providers will have an incentive to deliver efficient, high-quality care," says CMS Administrator Seema Verma. BPCI Advanced's Model Performance Period starts on Oct. 1, 2018, and runs through Dec. 31, 2023, during which time there will be a formal, independent evaluation to assess the quality of care and changes in spending under the model.

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