The number of healthcare providers participating in the CMS' advanced bundled payment model has declined by 16% since the program started five months ago, as providers choose to get out now to avoid financial risk.
BPCI Advanced participation dips 16% in first five months
The CMS announced Thursday that 1,086 healthcare providers are participating in the Bundled Payments for Care Improvement Advanced model, the first alternative payment model unveiled during the Trump administration. The model was initially rolled out by the CMS in October with 1,299 entities.
The BPCI Advanced model—which runs through Dec. 31, 2023—is a single retrospective bundled payment model that 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 BPCI Advanced model gives participants preliminary target benchmark prices before the start of the model year to help them plan.
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. However, that number has declined to 715 hospitals and 580 physician group practices for a total of 1,295 providers, according to CMS data.
The rollout of the model was bumpy, as the CMS was late in giving out claims data to providers, which they needed to decide which bundles to select. Providers had to determine whether to stay in the model by March 1.
The CMS announced the withdrawal option in early July, before BPCI participants officially had to sign agreements for the program in August. This raised the possibility that some would sign up for the program even if they were unprepared because they knew the withdrawal option was available to them, said Gina Bruno, vice president for clinical strategy at naviHealth, a convener for hospitals that participate in BPCI.
"For some it may have allowed them to take on more than they otherwise would or to maybe use the program as a testing ground," she said.
Considering the zero-risk withdrawal option, Bruno said the number of participants leaving the program was modest.
"We obviously had some participants leave, but it wasn't catastrophic—it's a testament to these organizations' commitment to value-based care."
The agency allowed participants to exit without penalty so they could "experience the model before making a final decision," a CMS spokesperson said, citing stakeholder feedback.
"Participants were able to engage in care redesign, receive preliminary target pricing information and receive monthly claims data before committing to the model," the spokesperson said.
The agency also announced Thursday that it is going to hold a second enrollment period for the BPCI Advanced model, with more information being available later this spring.
The CMS determines the benchmark price for an acute-care hospital by using risk adjustment models that include the patient case-mix, spending patterns at peer hospital groups and historical Medicare fee-for-service expenditures.
Some hospitals have complained that the benchmark prices are far too high. For instance, UCSF Medical Center in California found that the current way the program is structured would leave them more than $1 million in the hole.
Keeping hospitals in the bundled payment models has been a persistent problem for the CMS.
A report issued last year by the Government Accountability Office found that hospitals usually end their participation in bundled care models when they have to enter downside risk and if they don't think that financial success is guaranteed.
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