BPCI Model 4: Prospective Acute Care Hospital Stay Only

The Bundled Payments for Care Improvement (BPCI) initiative is comprised of four broadly defined models of care, which link payments for the 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.

Select anywhere on the map below to view the interactive version BPCI Model 4 Mapped

There are 10 awardees involved in the BPCI Model 4: Prospective Acute Care Hospital Stay Only. Many 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

In Model 4, CMS makes a single, prospectively determined bundled payment to the hospital that encompasses all services furnished by the hospital, physicians, and other practitioners during the Episode of Care, which lasts the entire inpatient stay. Physicians and other practitioners submit “no-pay” claims to Medicare and are paid by the hospital out of the bundled payment. Related readmissions for 30 days after hospital discharge are included in the bundled payment amount. Participants can select up to 48 different clinical condition episodes to test in the model. For more information on the other models, visit the BPCI Initiative: Model 1 web page, BPCI Initiative: Model 2 web page, or BPCI Initiative: Model 3 web page.

On January 31, 2013, the first cohort of BPCI participants was announced. By October 1, 2013, some BPCI participants entered into Awardee Agreements with CMS, at which point they began bearing financial risk. In November 2013, CMS offered a second Open Period for current Awardees to add additional Episode Initiators or clinical episodes in BPCI Model 4.  The second cohort of participants began their performance period on January 1, 2014.  CMS offered a third Open Period in February 2014 seeking additional organizations to participate in BPCI Model 4. The Open Period ended on April 18, 2014, and resulted in additional cohorts that began on April 1, and July 1, 2015.

Model 4 Awardees

As of July 1, 2015, the BPCI Model 4 has 10 participants in Phase 2. The 10 participants are comprised of 9 Awardees and 1 Episode Initiator involved in care redesign.  For Model 4, “Episode Initiator” means an acute care hospital that triggers an Episode of Care. The breakdown of participants by provider type is as follows: Acute Care Hospitals (9). Some Awardees are not initiating episodes in BPCI and therefore are not included in the breakdown of participants by provider type.

The information below represents BPCI Model 4 Awardees as of July 1, 2015 which are actively testing BPCI in Phase 2 at one or more episode-initiating sites::

  • Bronson Methodist Hospital (Kalamazoo, MI)
  • Florida Hospital (Orlando, FL)
  • Jersey Shore University Medical Center (Neptune, NJ)
  • Lancaster General Hospital (Lancaster, PA)
  • Methodist Hospital of Southern California (Arcadia, CA)
  • The Chambersburg Hospital (Chambersburg, PA)
  • The Cooper Health System (Camden, NJ)
  • The Waynesboro Hospital (Waynesboro, PA)
  • Valley Baptist Medical Center – Harligen (Harlingen, TX)

Convening organizations that bring together multiple health care providers but are not Awardees or Episode Initiators:

  • Valley Baptist Health System (Harlingen, TX)

Additional Information