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UNCERTAIN HOSPITALS MAY BENEFIT FROM APPLYING TO THE PROGRAM ON A TENTATIVE BASIS SO THAT THEY CAN REVIEW THEIR CMS-PROVIDED PERFORMANCE DATA, ADVISERS SAY.
Hospital participation in a new voluntary bundled payment program is expected to exceed that of any previous models, but the new program may not be right for every organization.
The Centers for Medicare & Medicaid Services (CMS) issued long-anticipated rules for the new model, Bundled Payments for Care Improvement Advanced (BPCI Advanced).
The model will allow participating organizations to earn additional payment if total spending on a beneficiary’s episode of care comes in under a spending target that factors in quality. Organizations that exceed targets will face payment cuts.
The new model will offer bundled pay for 32 clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient), according to a CMS release.
The new model generally drew positive reactions from the hospital industry and bundled payment experts.
“To us, this signals that the administration sees value in these programs,” said Darcie Hurteau, senior director of informatics for DataGen, a healthcare data analytics and policy firm that advises about 200 providers in various CMS payment models.
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