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.

Select anywhere on the map below to view the interactive version

This map as well as the "Number of Participants" referenced in the "Model Summary" section in the upper right hand column on this page is populated by data which only includes episode initiating Participants in the Initiative. Currently, 432 Participants comprised of 402 episode initiating Awardees and Episode Initiators, and additional 30 non-episode initiating Awardees, are 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).

Background

Model 2 involves a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care. Under this payment model, Medicare continues to make fee-for-service (FFS) payments to providers and suppliers furnishing services to beneficiaries in Model 2 episodes. The total expenditures for a beneficiary’s episode is later reconciled against a bundled payment amount (the target price) determined by CMS. A payment or recoupment amount is then made by Medicare reflecting the aggregate performance compared to the target price. In Model 2, the episode of care includes a Medicare beneficiary’s inpatient stay in the acute care hospital, post-acute care and all related services during the episode of care, which ends either 30, 60, or 90 days after hospital discharge. Awardees select up to 48 different clinical episodes to test in the model. 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.

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 2. 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 2. The Open Period ended on April 18, 2014, and resulted in many new participants joining BPCI initiative through the summer and fall of 2014.  Additional cohorts began on January 1, April 1, and July 1, 2015.

In December 2014, a timeline for transition to Phase 2 of BPCI was instituted. According to the timeline, every episode initiating organization, regardless of whether the Episode Initiator is directly bearing risk (as an Awardee) or is participating under an Awardee Convener, had to transition at least one Clinical Episode to Phase 2 by July 1, 2015 in order to remain in BPCI. The transition of all clinical episodes for all participants into Phase 2 was completed on September 30, 2015 at which point Phase 1 of BPCI ended. Phase 2 was previously scheduled to end after each participant completed a three year period of performance for each clinical episode entered into Phase 2. The BPCI initiative has been extended until September 30, 2018 for all BPCI Model 2, 3, and 4 Awardees that choose to sign an amendment extending their period of performance for all clinical episodes for up to 2 years.

Model 2 Awardees

As of July 1, 2018, BPCI Model 2 has 432 Participants in Phase 2. The 432 Participants are comprised of 131 Awardees and 301 Episode Initiators involved in care redesign. For Model 2, “Episode Initiator” means an acute care hospital or a physician group practice that triggers an episode of care. The breakdown of participants by provider type is as follows: Acute Care Hospitals (253), and Physician Group Practices (152). 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 2 Awardees as of July 1, 2018 which are actively testing BPCI in Phase 2 at one or more episode-initiating sites:

  • Abington Memorial Hospital (Abington, PA)
  • AccentCare Health Management, Inc. (Dallas, TX)*
  • Archway Health Advisors, LLC (Brookline, MA)*
  • Atlanticare Regional Medical Center, Inc. (Egg Harbor Township, NJ)
  • Aultman Hospital (Canton, OH)
  • Aventura Hospital and Medical Center (Aventura, FL)
  • Avera St. Luke's Hospital (Aberdeen, SD)
  • Banner Health (Phoenix, AZ)*
  • Baptist Medical Center (San Antonio, TX)
  • Bayshore Medical Center (Pasadena, TX)
  • Baystate Medical Center (Springfield, MA)
  • Beacon Health System (South Bend, IN)*
  • Bon Secours Charity Health System dba Saint Anthony Community Hospital (Warwick, NY)
  • Bon Secours Mary Immaculate Hospital (Newport News, VA)
  • Borgess Medical Center (Kalamazoo, MI)
  • Bowling Green Warren County Community Hospital Corp. dba The Medical Center (Bowling Green, KY)
  • Buffalo General Medical Center (Buffalo, NY)
  • Catholic Health Initiatives (Englewood, CO)*
  • Centegra Hospital – McHenry (McHenry, IL)
  • Centennial Hills Hospital Medical Center (Las Vegas, NV)
  • Chesapeake Regional Medical Center (Chesapeake, VA)
  • Cheyenne Regional Medical Center (Cheyenne, WY)
  • Christiana Care Health Services (Wilmington, DE)
  • Clear Lake Regional Medical Center (Webster, TX)
  • Delmarva Health Network, LLC (Lewes, DE)*
  • Denton Regional Medical Center ( Denton, TX)
  • Desert Springs Hospital (Las Vegas, NV)
  • Doctors Hospital of Williamsburg dba Riverside Doctors Hospital of Williamsburg (Williamsburg, VA)
  • Doylestown Hospital (Doylestown, PA)
  • Du Page Medical Group Ltd (Downers Grove, IL)
  • EMH Regional Medical Center (Elyria, OH)
  • First Health Moore Regional Hospital (Pinehurst, NC)
  • Florida Health Sciences Center, Inc. dba Tampa General Hospital (Tampa, FL)
  • Grand View Hospital (Sellersville, PA)
  • Greenville Health System (Greenville, SC)*
  • Halifax Hospital Medical Center (Daytona Beach, FL)
  • Health Choice Preferred Accountable Care LLC (Franklin, TN)*
  • Health Choice Utah Accountable Care LLC (Franklin, TN)*
  • Heartland Regional Medical Center (St Joseph, MO)
  • Holy Name Medical Center (Teaneck, NJ)
  • Hunterdon Medical Center (Flemington, NJ)
  • Infirmary Health System (Mobile, AL)*
  • JFK Medical Center (Atlantis, FL)
  • Jupiter Medical Center (Jupiter, FL)
  • Kent Hospital (Warwick, RI)
  • Kingwood Medical Center (Kingwood, TX)
  • Lahey Hospital and Medical Center (Burlington, MA)
  • Lake Health (Willoughby, OH)
  • Lancaster Hospital Corporation dba Palmdale Regional Medical Center (Palmdale, CA)
  • Liberty Health Partners LLC (Mercer Island, WA)*
  • Lodi Memorial Hospital Association, Inc. (Lodi, CA)
  • Loma Linda University Health Care (Loma Linda, CA)
  • Lowell General Hospital (Lowell, MA)
  • Marshall Medical Center (Placerville, CA)
  • Mary Washington Health Alliance LLC (Fredericksburg, VA)*
  • Maryview Hospital dba Bon Secours Maryview Medical Center (Portsmouth, VA)
  • Medical Center of Plano ( Plano, TX)
  • Medical City Dallas Hospital (Dallas, TX)
  • Memorial Health Services (Fountain Valley, CA)*
  • Memorial Hospital Jacksonville (Jacksonville, FL)
  • Memorial Regional Medical Center (Mechanicsville, VA)
  • Methodist Medical Center of Illinois (Peoria, IL)
  • Methodist Texsan Hospital, a Campus of Methodist Hospital (San Antonio, TX)
  • Montefiore Medical Center (Bronx, NY)
  • Mount Sinai Health System, Inc. (New York, NY)*
  • Mount Sinai Hospital (Chicago, IL)
  • NaviHealth, Inc. (Brentwood, TN)*
  • New York University Hospitals Center (New York, NY)
  • North Brevard County Hospital District dba Parrish Medical Center (Titusville, FL)
  • Northwell Health (North Shore LIJ Health Care Inc.) (Great Neck, NY)*
  • Northwestern Memorial Healthcare (Chicago, IL)*
  • Novato Community Hospital (Novato, CA)
  • OhioHealth Corporation (Columbus, OH)*
  • Orlando Health, Inc. (Orlando, FL)
  • Ortho New England Group, LLC (Boston, MA)*
  • Palos Community Hospital (Palos Heights, IL)
  • Parma Community General Hospital (Parma, OH)
  • Peacehealth St John Medical Center (Longview, WA)
  • Plaza Medical Center of Fort Worth (Ft. Worth, TX)
  • Raleigh Orthopaedic Clinic, PA (Raleigh, NC)
  • Randolph Hospital Inc. (Asheboro, NC)
  • Regional Medical Center of Orangeburg and Calhoun Counties (Orangeburg, SC)
  • Remedy BPCI Partners, LLC (Darien, CT)*
  • Riverside Community Hospital (Riverside, CA)
  • Riverside Hospital Inc. dba Riverside Regional Medical Center (Newport News, VA)
  • Riverside Middle Peninsula Hospital Inc. dba Riverside Walter Reed Hospital (Gloucester, VA)
  • Riverside Tappahannock Hospital Inc. (Tappahannock, VA)
  • Rush University Medical Center (Chicago, IL)*
  • Saint Francis Downtown (Greenville, SC)
  • Saint Joseph Regional Medical Center-Mishawaka Campus (Mishawaka, IN)
  • Saint Mary's Hospital of Richmond Inc. (Richmond, VA)
  • Shore Health Services Inc. dba Riverside Shore Memorial Hospital (Nassawadox, VA)
  • Signature Healthcare (Brockton, MA)*
  • Signature Medical Group, Inc. (Saint Louis, MO)
  • Silver Cross Hospital And Medical Centers, Inc. (New Lenox, IL)
  • Sisters of Charity Providence Hospitals (Columbia, SC)
  • South Nassau Communities Hospital (Oceanside, NY)
  • South Shore Physician Hospital Organization, Inc. (South Weymouth, MA)*
  • Southwest General Health Center (Middleburg Heights, OH)
  • Sparks Family Hospital Inc. dba Northern Nevada Medical Center (Sparks, NV)
  • Spartanburg Regional Health Services District, Inc. (Spartanburg, SC)*
  • Spring Valley Medical Center (Las Vegas, NV)
  • St Vincent’s Healthcare (Jacksonville, FL)*
  • St. Luke's Hospital (Bethlehem, PA)
  • St. Mary Medical Center Langhorne PA (Langhorne, PA)
  • St. Mary's Medical Center Of Evansville, Inc. (Evansville, IN)
  • Steward Integrated Care Network, Inc. (Boston, MA)*
  • Stryker Performance Solutions, LLC (Chicago, IL)*
  • Summerlin Hospital Medical Center LLC dba Summerlin Hospital Medical Center (Las Vegas, NV)
  • Temecula Valley Hospital Inc. dba Temecula Valley Hospital (Temecula, CA)
  • The Cleveland Clinic Health System (Independence, OH)*
  • The Guthrie Clinic (Sayre, PA)*
  • The Rutland Hospital (Rutland, VT)
  • The University of Texas Southwestern Medical Center at Dallas (Dallas, TX)
  • The Valley Hospital
  • Tucson Orthopaedic Institute, PC (Tucson, AZ)
  • UMASS Memorial Medical Center, Inc. (Worcester, MA)
  • United Surgical Partners International Surgical Services (Addison, TX)*
  • Universal Health Services of Rancho Springs Inc. dba Southwest Healthcare System (Murrieta, CA)
  • University Health Services, Inc. (Augusta, GA)
  • University Hospitals Cleveland Medical Center (Cleveland, OH)
  • University of Alabama Hospital (Birmingham, AL)
  • University of California Irvine dba UC Irvine Medical Center (Orange, CA)
  • University of California San Francisco Medical Center (San Francisco, CA)
  • University of Chicago Medicine (Chicago, IL)
  • University of Rochester Medical Center (Rochester, NY)*
  • University of Tennessee Medical Center (Knoxville, TN)
  • University of Utah Health Care (Salt Lake City, UT)
  • Valley Hospital Medical Center (Las Vegas, NV)
  • Vanderbilt University Medical Center (Nashville, TN)
  • VHS of Michigan - Detroit Medical Center (Detroit, MI)*
  • Virtua West Jersey Health System Inc. (Voorhees, NJ)
  • Washington Regional Medical Center (Fayetteville, AR)
  • Wellington Regional Medical Center (Wellington, FL)
  • Wentworth-Douglass Hospital (Dover, NH)
  • West Hills Hospital & Medical Center (West Hills, CA)
  • West Palm Beach Physician Group, Inc. (Sunrise, FL)
  • Westside Regional Medical Center (Plantation, FL)
  • White River Health System (Batesville, AR)
  • Winthrop-University Hospital (Mineola, NY)
  • Yale-New Haven Hospital (New Haven, CT)

* Organizations that are Awardees but non-episode initiating are not included in the "Number of Participants" referenced in the "Model Summary" section of this page.

 

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

  • Association of American Medical Colleges (Washington, DC)
  • Centegra Health System (Crystal Lake, IL)
  • Estes Park Institute, at Horty, Springer & Mattern (Pittsburgh, PA)
  • First Coast Health Alliance, LLC (St. Augustine, FL)
  • Geisinger Clinic (Danville, PA)
  • HCA Management Services, L.P. (Nashville, TN)
  • Navvis Healthcare, LLC (Ballwin, MO)
  • NuVista Health Systems, LLC (Wellington, FL)
  • Premier, Inc. (Charlotte, NC)
  • Stryker Performance Solutions, LLC (Chicago, IL)

 

Three-Day Hospital Stay Waiver

A waiver of the 3-Day Hospital Stay Requirement for SNF Payment (“Waiver”) is available to Model 2 BPCI 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 the Waiver, 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