The Bundled Payments for Care Improvement initiative is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare. For more information on the background of this initiative, various types of models, or details on episodes of care, visit BPCI Initiative: General Information.
In Model 1, the episode of care is defined as the inpatient stay in the acute care hospital. Medicare pays the hospital a discounted amount based on the payment rates established under the Inpatient Prospective Payment System used in the original Medicare program. Medicare continues to pay physicians separately for their services under the Medicare Physician Fee Schedule. Participation began in April, 2013 and an additional Awardee was added in January, 2014 and includes most Medicare fee-for-service discharges for the participating hospitals. For more information on the other models, visit the BPCI Initiative: Model 2 web page, or BPCI Initiative: Model 3 web page, or BPCI initiative: Model 4 web page.
Currently BPCI Model 1 has 12 Awardees, including 1 convener of health care organizations, representing 12 providers actively testing the model in Phase 2.
There are 12 participants/awardees involved in the BPCI Model 1: Retrospective Acute Care Hospital Stay Only. Many participants/awardees comprise numerous sites and can be accessed as a (List).
To view an interactive map of this Model, visit the Where Innovation is Happening page.
Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient.
Research has shown that bundled payments can align incentives for providers – hospitals, post-acute care providers, doctors, and other practitioners – to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery.
On January 31, 2013, CMS announced the selection of awardees into Model 1. In the summer of 2013, CMS had an open period to allow organizations to submit new requests to participate in BPCI Model 1 and welcomed a new Awardee in January 2014
Model 1 Awardees
The information below represents current BPCI Model 1 Awardees which are actively testing BPCI at one or more episode-initiating sites:
- Inspira Medical Center Elmer (Elmer, NJ)
- Inspira Medical Center Vineland (Vineland, NJ)
- Inspira Medical Center Woodbury (Woodbury, NJ)
- Kansas Surgery & Recovery Center (Wichita, KS)
- Robert Wood Johnson University Hospital Hamilton (Hamilton, NJ)
- Robert Wood Johnson University Hospital (New Brunswick, NJ)
- Robert Wood Johnson University Hospital Rahway (Rahway, NJ)
- Saint Clare's Hospital (Denville/Dover) (Denville, NJ)
- Saint Peter's University Hospital (New Brunswick, NJ)
- St. Joseph's Regional Medical Center, St. Joseph's Wayne Hospital (Wayne, NJ)
- St. Mary's Hospital Passaic (Passaic, NJ)
- University Medical Center of Princeton at Plainsboro (Plainsboro, NJ)
- BPCI initiative: General Information
- BPCI initiative: Model 2
- BPCI initiative: Model 3
- BPCI initiative: Model 4
- BPCI Initiative Episode Analytic File (ZIP) (updated 03/19/15)