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 4, CMS makes a single, prospectively determined bundled payment to the hospital that encompasses all services furnished during the inpatient stay by the hospital, physicians, and other practitioners. 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. 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.
Currently BPCI Model 4 has 10 Awardees, including 1 convener of health care organizations, representing 10 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 7 participants, including 1 convener of health care organizations, representing 7 providers are currently in Phase 1 of BPCI. See below for further information on the phases of BPCI.
There are 18 participants/awardees involved in the BPCI Model 4: Prospective 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.
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 4 Awardees
The below represents current BPCI Model 4 Awardees which are actively testing BPCI 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)
- St. Luke's Hospital (Chesterfield, MO)
- Torrance Memorial Medical Center (Torrance, CA)
- University of California San Francisco Medical Center (San Francisco, CA)
- University of Colorado Hospital (Aurora, CO)
- Valley Baptist Health System (Harlingen, TX)