BPCI Model 2: Retrospective Acute & Post Acute Care Episode

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 2, the episode of care includes the inpatient stay in the acute care hospital and all related services during the episode. The episode ends either 30, 60, or 90 days after hospital discharge. Participants select up to 48 different clinical condition episodes. For more information on the other models, visit the BPCI Initiative: Model 1 web page, BPCI Initiative: Model 3 web page, or BPCI Initiative: Model 4 web page.

Currently BPCI Model 2 has 60 Awardees, including 24 conveners of health care organizations, representing 112 providers actively testing the model in Phase 2. Since the BPCI Winter 2014 Open Period seeking submissions from additional entities for participation in BPCI Models 2-4 ended on April 18, 2014, BPCI has welcomed additional participants into Phase 1 and will continue to accept new participants from the Open Period as initial screening and documentation are completed. An additional 596 participants, including 76 conveners of health care organizations, representing 1,964 providers are currently in Phase 1 of BPCI. See below for further information on the phases of BPCI.

BPCI Model 2 mappedClick anywhere on the map to view the interactive version

There are 2,150 participants/awardees involved in the BPCI Model 2: Retrospective Acute & Post Acute Care Episode. 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

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.

The Bundled Payments for Care Improvement initiative includes two phases for Models 2, 3, and 4.  Phase 1, also referred to as the “preparation” period, is the initial period of the initiative during which CMS and participants prepare for implementation and assumption of financial risk. Those participants in Phase 1 of Models 2, 3, and 4 that are approved by CMS and intend to assume financial risk for episodes may enter into a Bundled Payments for Care Improvement Model agreement with CMS as Awardees and begin Phase 2, also referred to as the “risk-bearing” period.

On January 31, 2013, the first set of Bundled Payments for Care Improvement Phase 1 participants were announced. Recently, CMS offered an additional Winter 2014 Open Period seeking submissions from additional entities for participation in BPCI Models 2-4. The period ended on April 18, 2014 and many new participants from this offering were welcomed into Phase 1 in late June 2014. CMS is continuing to review submissions from the Winter 2014 Open Period and may accept additional participants in Phase 1.

Phase 2 began either on October 1, 2013 or January 1, 2014 for current Awardees that entered into Model 2 Awardee Agreements with CMS, at which point Awardees began the risk-bearing phase for some or all of their episodes. The complete transition of all episodes for all Episode Initiators to Phase 2 will be completed by January 2015. During the transition period, Awardees may transition episodes and/or Episode Initiators that have remained in Phase 1 to Phase 2 on a quarterly basis.

Model 2 Awardees

The below list represents current BPCI Model 2 Awardees which are actively testing BPCI at one or more episode-initiating sites:

  • Banner Health (Phoenix, AZ)
  • Baptist Medical Center (San Antonio, TX)
  • Bayonne Medical Center (Bayonne, NJ)
  • Baystate Medical Center (Springfield, MA)
  • Billings Clinic (Billings, MT)
  • Blue Ridge Healthcare System-Grace Hospital Inc. (Morganton, NC)
  • Borgess Medical Center (Kalamazoo, MI)
  • Canton-Potsdam Hospital (Potsdam, NY)
  • Catholic Health Initiatives (Englewood, CO)
  • Centra Health, Inc (Lynchburg, VA)
  • CoxHealth (Springfield, MO)
  • Doylestown Hospital (Doylestown, PA)
  • Duke University Hospital (Durham, NC)
  • First Health Moore Regional Hospital (Pinehurst, NC)
  • Geisinger Medical Center (Danville, PA)
  • Geisinger Wyoming Valley (Wilkes-Barre, PA)
  • Harrisburg Hospital and Community General Osteopathic Hospital (Harrisburg, PA)
  • Health Choice Preferred Accountable Care LLC (Franklin, TN)
  • Health Choice Utah Accountable Care LLC (Franklin, TN)
  • Holy Name Medical Center (Teaneck, NJ)
  • Kent Hospital (Warwick, RI)
  • Lahey Hospital and Medical Center (Burlington, MA)
  • Lodi Memorial Hospital Association, Inc. (Lodi, CA)
  • Maine Heart Center (Portland, ME)
  • Marshall Medical Center (Placerville, CA)
  • Memorial Health University Medical Center (Savannah, GA)
  • Mercy St. Vincent Medical Center (Toledo, OH)
  • Meriter Hospital, Inc. (Madison, WI)
  • Methodist Medical Center of Illinois (Peoria, IL)
  • Milton S. Hershey Medical Center (Hershey, PA)
  • Montefiore Medical Center (Bronx, NY)
  • Mount Sinai Hospital (Chicago, IL)
  • NaviHealth, Inc. (Brentwood, TN)
  • New York University Hospitals Center (New York, NY)
  • North Shore LIJ Health Care Inc (Great Neck, NY)
  • Our Lady of the Lake Regional Medical Center (Baton Rouge, LA)
  • Pocono Medical Center (East Stroudsburg, PA)
  • Presence Health Network (Chicago, IL)
  • Remedy BPCI Partners, LLC (Darien, CT)
  • Saint Joseph Regional Medical Center-Mishawaka Campus (Mishawaka, IN)
  • Signature Medical Group, Inc. (Saint Louis, MO)
  • Silver Cross Hospital and Medical Centers, Inc. (New Lenox, IL)
  • SSM DePaul Health Center (Bridgeton, MO)
  • SSM St. Mary's Health Center (Richmond Heights, MO)
  • St Vincents Healthcare (Jacksonville, FL)
  • St. Mary Medical Center Langhorne PA (Langhorne, PA)
  • St. Mary's Hospital (Richmond, VA)
  • Sutter West Bay Hospitals (San Francisco, CA)
  • The Cleveland Clinic Health System (Independence, OH)
  • The Rutland Hospital (Rutland, VT)
  • Touchstone Health (White Plains, NY)
  • University of Alabama Hospital (Birmingham, AL)
  • Vanderbilt University Medical Center (Nashville, TN)
  • Vanguard Health Chicago (Westmont, IL)
  • VHS of Michigan - Detroit Medical Center (Detroit, MI)
  • Wentworth-Douglass Hospital (Dover, NH)
  • Winthrop-University Hospital (Mineola, NY)

 

Three-Day Hospital Stay Waiver

In the Bundled Payments for Care Improvement Initiative (BPCI), the waiver of the 3-Day Hospital Stay Requirement for SNF Payment (“Waiver”) is available to Awardees testing the episode payment  model that spans the acute care hospitalization and post-discharge care, for an episode length that can range from 30 to 90 days. Under this retrospective payment model, Medicare continues to make fee-for-service (FFS) payments to providers and suppliers furnishing services to beneficiaries in Model 2 episodes, after which the total payment for a beneficiary’s episode is reconciled against a bundled payment amount (the target price) predetermined by CMS. An Awardee may be a single Medicare provider or supplier or a convening organization that coordinates multiple health care providers’ participation in BPCI. Model 2 Episode Initiators are acute care hospitals (ACH) or physician group practices (PGP). When an ACH is an Episode Initiator, an episode is initiated when an eligible beneficiary is admitted as an inpatient to the ACH for one of the included MS-DRGs in the episode. When a PGP is an Episode Initiator, an episode is initiated when an eligible beneficiary is admitted as an inpatient to any ACH for one of the included MS-DRGs in the episode and a physician in the PGP is the attending or operating physician for the inpatient stay.

The scope of the Waiver is that the requirement in Section 1861(i) of the Social Security Act for a 3-day inpatient hospital stay prior to Medicare Part A covered skilled nursing facility (SNF) services is waived for  Model 2 Awardees, given certain provisions and requirements. The Waiver allows Model 2 BPCI beneficiaries who are discharged from an inpatient hospital stay of less than 3 days to receive post-hospital care from skilled nursing facilities (SNFs), covered under Medicare Part A, as long as all other coverage requirements are satisfied. The Waiver is made available to Awardees that provide a list of their SNF partners to CMS, where a majority of the SNF partners for a specified period of time had a quality rating of 3 or more stars under the CMS 5-Star Quality Rating System.

This Three-Day Hospital Stay Waiver document (PDF) reflects Model 2 Awardees that are currently eligible to utilize the Three-Day Hospital Stay Requirement for SNF Payment waiver, their Episode Initiators, and Model 2 episodes for which the Waiver can be used.

Additional Information



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