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Introducing the BPCI-Advanced Model Year 4

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As a healthcare provider, you’re always looking for ways to improve patient care while reducing costs. The Bundled Payments for Care Improvement Advanced (BPCI-Advanced) is a great opportunity to do both. It is a Centers for Medicare & Medicaid Services (CMS) initiative that encourages healthcare providers to deliver high-quality, coordinated care. And now, with Model Year 4 of BPCI-Advanced, there are new opportunities to get enhance the system and make it work better for you and your patients. Let’s take a look at what you need to know about the BPCI-Advanced Model Year 4.

What is BPCI-Advanced?

BPCI-Advanced is a voluntary, bundled payment program created by the Centers for Medicare & Medicaid Services (CMS) that allows hospitals and physicians to work together to improve the quality and coordination of care while also reducing costs. In BPCI Advanced, CMS pays participating providers a single bundle payment for an episode of care. This means that providers are incentives to work together to deliver coordinated, high-quality care because they are financially responsible for the cost and quality of care delivered during the episode.The approach encourages providers to focus on improving patient outcomes and reducing unnecessary costs. With BPCI models coming up, one can restructure their care processes to deliver better quality at a reduced cost. Along with health navigator services and data analytics, it would be easier to reduce hospital readmissions and duplication of services, too, making the whole system and process more efficient.

What’s new in BPCI-Advanced Model Year 4?

Here is a breakdown of the 3 significant changes made by CMS to BPCI Advanced Model Year 4:

1. Clinical Episode Service Line Groups (CESLGs)

In Model Year 4 of BPCI-Advanced, CMS has introduced 8 clinical episode service line groupings for participants to choose from. These new groupings will be locked in for three years, which means participants cannot drop them and still remain in the program. They must participate in all clinical episodes within per grouping unless they don’t complete the minimum volume threshold for a component clinical episode during the baseline period.

2. Overlap Methodology

The biggest change for Model Year 4 is the exclusion of clinical episodes that would have been typically initiated while a beneficiary has an ongoing independent clinical episode. This, in effect, means no BPCI-Advanced clinical episodes will overlap. It is important to note that this excludes overlapping clinical episodes irrespective of if the initial ongoing episode was attributed to a BPCI-Advanced participant.

3. Peer Group Trend Adjustment

Model Year 4 of BPCI-Advanced also introduces retrospective peer group trend adjustment. This means that at the end of the performance period, CMS will adjust the final Target Prices for peer group trends found in Clinical Episode spending. This is a significant change because it will create more stability for participants and allow them to better predict their potential savings.

Wrapping Up

These are the three big changes in BPCI Advanced Model Year 4 that you should know about. Remember, the program is voluntary, so do a complete cost-benefit analysis before deciding whether or not to participate. So far, the BPCI-Advanced program has been successful in reducing costs and improving the quality of care, and with these new changes in Model Year 4, it is sure to continue that trend.
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