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The Most Important Factor in BPCI Advanced Target Prices

By: Darcie Hurteau

DataGen was recently featured on www.ajmc.com.

The BPCI Advanced program, the successor to Bundled Payments for Care Improvement (BPCI), involves Medicare’s most sophisticated strategy for setting episode target prices among its bundled payment initiatives to date. Previously, Medicare acute care bundled payment programs utilized more facile target price adjustment strategies, adjusting target prices by episode, through Medicare Severity Diagnostic Related Group (MS-DRG), as seen in BPCI classic, and fracture status, as seen in Comprehensive Care for Joint Replacement (CJR). These strategies have been subject to scrutiny due to the lack of adjustment for other significant patient characteristics. While developing BPCI Advanced target process, CMS created a patient case mix adjustment (PCMA) factor to remediate the limitations of those early approaches—controlling for additional patient level characteristics within a clinical episode category.

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