Major changes coming to BPCIA

DATE: 09/16/2020

Last week, the Centers for Medicare and Medicaid Services announced sweeping changes for Model Year 4 of the Bundled Payments for Care Improvement Advanced program. CMS’ own research has revealed that as it currently stands, BCPIA will cause CMS to lose $2 billion over the course of the program.

As a result, CMS is making several changes intended to prevent the overall cancelation of BPCIA. DataGen has reviewed and analyzed CMS’ documentation on these changes. Here are the ones we found to be the most notable:

  • Changes to the program targets will make them more accurate for the program overall; therefore, targets may not be as favorable to participants as in the previous model years, illustrated from Acumen’s analysis.
  • Participants are now required to operate in clinical episode service groups rather than at the individual episode level. For example, if a participant who is currently at risk for sepsis episodes wants to continue to carry that risk in Model Year 4, they will also be required to go at risk for five other clinical episodes.
  • CMS stated that it has the right to cancel any model if the financial savings do not remain in line with quality improvement.
  • CMS also announced that there will be an anticipated mandatory model at the conclusion of BPCIA.

These changes will have major impacts on participants, who should be working now to educate themselves on what these changes mean for their participation. Aside from the many changes, the announcement of an anticipated mandatory model still gives participants incentives to remain in BPCIA.

To provide additional insight on this, DataGen’s manager of business intelligence analytics, John Kalamaras, recently shared his thoughts on these changes in an interview with the Healthcare Financial Management Association. Read it now or reach out to DataGen today to learn more about how you can prepare for these changes.