BPCI Model 2: Retrospective Acute & Post Acute Care Episode

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.

In Model 2, the episode of care will include the inpatient stay in the acute care hospital and all related services during the episode. The episode will end either 30, 60, or 90 days after hospital discharge. Participants can select up to 48 different clinical condition episodes.

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

There are 107 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.Phase 2 began either on October 1, 2013 or January 1, 2014 for Awardees that have 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 participants

Phase 1 Participants

  • Adventist Medical Center (Portland,OR): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Adventist Medical Center – Hanford (Hanford, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Albert Einstein Healthcare Network (AEHN) (Philadelphia, PA): This Awardee is a convener of health care facilities in PA in Phase 1, and is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • Amedisys Holdings (Baton Rouge, LA): This Awardee is a convener of health care facilities in AL, ID, IN, LA, NY, OH, PA, SC, WA and WV in Phase 1.
  • AnMed Health Medical Center (Anderson, SC): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Avera McKennan Hospital & University Health Center (Sioux Falls, SD): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Avera St. Luke's Hospital (Aberdeen, SD): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Avera St. Mary's Hospital (Pierre, SD): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Banner Health (Phoenix, AZ): This Awardee is a convener of health care facilities in AZ in Phase 1.
  • BJC Healthcare (St. Louis, MO): This participant is a convener of health care facilities in DE and MO and is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC) in Phase 1.   
  • Castle Medical Center (Kailua, HI): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Catholic Health Initiatives (Englewood, CO): This Awardee is a convener of health care facilities in CO, IA, KY, NE, and TN in Phase 1.
  • Central Valley General Hospital (Hanford, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Cheyenne Regional Medical Center (Cheyenne, WY): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • The Cleveland Clinic Health System (Cleveland, OH): This Awardee is a convener of health care facilities in OH in Phase 1.
  • El Camino Hospital (Mountain View, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • EMH Regional Medical Center (Elyria, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Feather River Hospital (Paradise, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Glendale Adventist Medical Center (Glendale, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Heartland Regional Medical Center (St Joseph, MO): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Methodist Charlton Medical Center (Dallas, TX): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Methodist Dallas Medical Center (Dallas, TX): This Participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Methodist Hospital of Surgery (Addison, TX): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Methodist Mansfield Medical Center (Mansfield, TX): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Methodist McKinney Hospital (McKinney, TX): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Methodist Richardson Medical Center (Richardson, TX): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • NaviHealth, Inc. (Brentwood, TN): This Awardee is a convener of health care facilities in AZ, CA, NV, TX in Phase 1.
  • Oakwood Healthcare Inc (Dearborn, MI): This participant is a convener of health care facilities in MA and MI, and is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC) in Phase 1.
  • Parma Community General Hospital (Parma, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • PeaceHealth Sacred Heart – Univ District (Eugene, OR): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  •  PeaceHealth Sacred Heart – Riverbend (Springfield, OR): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • PeaceHealth Southwest Medical Center (Vancouver, WA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • PeaceHealth St John Medical Center (Longview, WA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • PeaceHealth St Joseph Medical Center (Bellingham, WA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Rapid City Regional Hospital (Rapid City, SD): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Regional Medical Center of Orangeburg and Calhoun Counties (Orangeburg, SC): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Remedy BPCI Partners, LLC (Darien, CT): This Awardee is a convener of health care facilities in AL, AR, AZ, CA, CO, CT, DE, FL, GA, IA, ID, IL, IN, KY, LA, MA, MI, MN, MO, MS, MT, NC, NE, NH, NJ, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, WA, WI, and WY in Phase 1.
  • Rockford Memorial Hospital (Rockford, IL): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • San Joaquin Community Hospital (Bakersfield, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Signature Health Services, Inc. (Saint Louis, MO): This Awardee is a convener of health care facilities in AL, AR, AZ, CA, CO, CT, FL, GA, IA, IL, IN, KS, KY, MO, MI, MN, NC, NV, NY, OH, OK, OR, TN, TX, VA, WA in Phase 1.
  • Simi Valley Hospital (Simi Valley, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Sonora Regional Medical Center (Sonora, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Southwest General Health Center (Middleburg Heights, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Spearfish Regional Hospital (Spearfish, SD): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • St. Helena Hospital - Napa Valley (St. Helena, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Sutter West Bay Hospitals Inc. (San Francisco, CA): This Awardee is a convener of health care facilities in CA in Phase 1.
  • Touchstone Health (White Plains, NY): This Awardee is a convener of health care facilities in NJ and NY in Phase 1.
  • UH Regional Hospitals (Richmond Heights, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Ukiah Valley Medical Center (Ukiah, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • University Hospitals Ahuja Medical Center, Inc. (Beachwood, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • University Hospitals Cleveland Medical Center (Cleveland, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • University Hospitals Geauga Medical Center (Chardon, OH): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Vanguard Health Chicago (Chicago, IL): This Awardee is a convener of health care facilities in IL in Phase 1.
  • Walla Walla General Hospital (Walla Walla, WA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • White Memorial Medical Center (Los Angeles, CA): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • White River Health System (Batesville, AR): This participant is participating in Phase 1 in collaboration with the convener, Premier, Inc. (Charlotte, NC).

 

Phase 2 Awardees

  • Albert Einstein Healthcare Network (AEHN) (Philadelphia, PA): This Awardees a convener of health care facilities in PA, and is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • AnewCare (Johnson City, TN): This Awardee is a convener of health care facilities in TN and VA, and is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • Aultman Hospital (Canton, OH): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • Banner Heart Hospital (Phoenix, AZ): This Awardee is a convener of health care facilities in AZ.
  • Baptist Medical Center (San Antonio, TX)
  • Bayonne Medical Center (Bayonne, NJ): This Awardee is a convener of health care facilities in NJ.
  • Baystate Medical Center (Springfield, MA): This Awardee is participating in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Billings Clinic (Billings, MT): This Awardee is participating in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Blue Ridge Healthcare System-Grace Hospital Inc. (Morganton, NC): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • Borgess Medical Center (Kalamazoo, MI)
  • Canton-Potsdam Hospital (Potsdam, NY): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • Catholic Health Initiatives (Englewood, CO): This Awardee is a convener of health care facilities in AR, IA and NE in Phase 2.
  • Centra Health, Inc. (Lynchburg, VA)
  • Cleveland Clinic Health System (Cleveland, OH): The Awardee is a convener of health care facilities in OH in Phase 2.
  • CoxHealth (Springfield , MO)
  • Doylestown Hospital (Doylestown, PA)
  • Duke University Hospital (Durham, NC): This Awardee is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • First Health Moore Regional Hospital (Pinehurst , NC)
  • Geisinger Medical Center (Danville, PA): This Awardee is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • Geisinger Wyoming Valley (Wilkes-Barre, PA): This Awardee is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • Harrisburg Hospital and Community General Osteopathic Hospital (Harrisburg, PA): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • Health Choice Preferred Accountable Care LLC (Franklin, TN): This Awardee is a convener of health care facilities in AZ.
  • Health Choice Utah Accountable Care LLC (Franklin, TN): This Awardee is a convener of health care facilities in UT.
  • Holy Name Medical Center (Teaneck, NJ): This Awardee is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • Kent Hospital (Warwick, RI)
  • Lahey Hospital and Medical Center (Burlington, MA): This Awardee is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • Lodi Memorial Hospital Association, Inc. (Lodi, CA)
  • Maine Heart Center (Portland, ME): This Awardee is a convener of health care facilities in ME.
  • Marshall Medical Center (Placerville, CA): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • Memorial Health University Medical Center (Savannah, GA): This Awardee is participating in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Mercy St. Vincent Medical Center (Toledo, OH)
  • Meriter Health Services, Inc. (Madison, WI)
  • Methodist Medical Center of Illinois (Peoria, IL): This Awardee is participating in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Milton S. Hershey Medical Center (Hershey, PA): This Awardee is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • Montefiore Medical Center (Bronx, NY)
  • Mount Sinai Hospital (Chicago, IL): This Awardee is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • NaviHealth, Inc. (Brentwood, TN): This Awardee is a convener of health care facilities in CA, NJ, NM, OK, and TN.
  • New York University Hospitals Center (New York City, NY): This Awardee is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • North Shore LIJ Health Care Inc (Great Neck, NY): This Awardee is a convener of health care facilities in NY.
  • Our Lady of the Lake Regional Medical Center (Baton Rouge, LA): This Awardee is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • Presence Health Network (Chicago, IL): This Awardee is a convener of health care facilities in IL.
  • Pocono Medical Center (East Stroudsburg, PA). This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • Remedy BPCI Partners, LLC (Darien, CT): This Awardee is a convener of health care facilities in CT, NJ, NY, PA, and RI in Phase 2.
  • The Reading Hospital and Medical Center (West Reading, PA): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • The Rutland Hospital (Rutland, VT): This Awardee is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • Saint Joseph Regional Medical Center-Mishawaka Campus (Mishawaka, IN): This Awardee is participating in collaboration with the convener, Premier, Inc. (Charlotte, NC).
  • Signature Health Services, Inc. (Saint Louis, MO): This Awardee is a convener of health care facilities in KS in Phase 2.
  • Silver Cross Hospital and Medical Centers, Inc (New Lenox, IL)
  • SSM DePaul Health Center (Bridgeton, MO): This Awardee is participating in collaboration with the convener, SSM Managed Care Organization (St. Louis, MO).
  • SSM St. Mary's Health Center (Richmond Heights, MO): This Awardee is participating in collaboration with the convener, SSM Managed Care Organization (St. Louis, MO).
  • St. Mary's Hospital (Richmond, VA): This Awardee is participating in collaboration with the convener, Geisinger Clinic (Danville, PA).
  • St. Mary Medical Center Langhorne PA (Langhorne , PA)
  • St Vincents Healthcare (Jacksonville, FL): This Awardee is a convener of health care facilities in FL.
  • Sutter West Bay Hospitals Inc. (San Francisco, CA): This Awardee is a convener of health care facilities in CA in Phase 2.
  • Touchstone Health (White Plains, NY): This Awardee is a convener of health care facilities in NY in Phase 2.
  • University of Alabama Hospital (Birmingham, AL)
  • Vanderbilt University Medical Center (Nashville, TN): This Awardee is participating in collaboration with the convener, Association of American Medical Colleges (Washington, DC).
  • Vanguard Health Chicago (Chicago, IL): This Awardee is a convener of health care facilities in IL in Phase 2.
  • VHS of Michigan - Detroit Medical Center (Detroit, MI): This Awardee is a convener of health care facilities in MI.
  • Wentworth-Douglass Hospital (Dover, NH): This Awardee is participating in collaboration with the convener, Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA).
  • 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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