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Big Medicare bundled payment changes could cut participation, advisers say

By: Rich Daly, HFMA senior writer and editor

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  • Medicare has made changes to the Bundled Payments for Care Improvement Advanced model, including requirements for broader service line participation.
  • Mandatory participation is planned for 2024.
  • Some participants are likely to leave due to costs that the new requirements would impose on hospitals hit by the pandemic.

Medicare recently told participants in its largest bundled payments program about big changes that will go into effect in less than four months. The changes may lead some to drop out, advisers warn.

On Sept. 10, Medicare notified participants in the Bundled Payments for Care Improvement Advanced (BPCI-A) program about a slew of changes that will be effective Jan. 1, including:

  • Using a realized-trend adjustment (RTA)
  • Requiring participation in clinical episode service line groups rather than in individual episodes
  • Addressing the overlapping methodology of clinical episodes
  • Removing the physician group practice offset
  • Establishing additional risk adjustments for major joint replacement episodes

CMS also plans to implement a mandatory bundled payments model after BPCI-A ends in 2024.

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