BPCI Model 1: Retrospective Acute Care Hospital Stay Only

Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare.

Under Model 1, the episode of care is defined as the inpatient stay in the acute care hospital. Medicare will pay the hospital a discounted amount based on the payment rates established under the Inpatient Prospective Payment System used in the original Medicare program. Medicare will continue to pay physicians separately for their services under the Medicare Physician Fee Schedule. Under certain circumstances, hospitals and physicians are permitted to share gains arising from the providers’ care redesign efforts. Participation will begin as early as April, 2013 and no later than January, 2014 and will include most Medicare fee-for-service discharges for the participating hospitals.

BPCI Model 1 mappedClick anywhere on the map to view the interactive version

There are 21 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.

Background

Traditionally, Medicare makes separate payments to providers for each of the individual services they furnish to beneficiaries for a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished. Research has shown that bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners– allowing them to work closely together across all specialties and settings.

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. There are currently 21 Awardees that are testing bundled payments for acute care hospital stays.

Model 1 participants

  • Capital Health Medical Center – Hopewell (Pennington, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Capital Health Regional Medical Center (Trenton, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Deborah Heart and Lung Center (Browns Mills, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Hunterdon Medical Center (Flemington, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Inspira Medical Center Elmer (Elmer, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Inspira Medical Center Vineland (Vineland, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Inspira Medical Center Woodbury (Woodbury, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • JFK Medical Center (Edison, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Kansas Surgery & Recovery Center (Wichita, KS).
  • Morristown Medical Center (Morristown, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Overlook Medical Center (Summit, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Robert Wood Johnson University Hospital (New Brunswick, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Robert Wood Johnson University Hospital Hamilton (Hamilton, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Robert Wood Johnson University Hospital Rahway (Rahway, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Saint Clare's Hospital (Denville/Dover) (Denville, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Saint Michael's Medical Center (Newark, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • Saint Peter's University Hospital (New Brunswick, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • St. Joseph's Regional Medical Center, St. Joseph's Wayne Hospital (Wayne, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • St. Mary's Hospital Passaic (Passaic, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • The Valley Hospital (Ridgewood, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).
  • University Medical Center of Princeton at Plainsboro (Plainsboro, NJ): This Awardee is participating in collaboration with the convener, New Jersey Hospital Association (New Jersey).

Additional Information



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