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

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, 2 Participants comprised of 2 episode initiating Awardees are involved in the BPCI Model 4: Prospective Acute Care Hospital Stay Only. Many awardees comprise numerous sites and can be accessed as a (List).

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.

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 4 Awardees

As of Julyl 1, 2017, the BPCI Model 4 has 2 participants in Phase 2. The 2 participants are comprised of 2 Awardees and 0 Episode Initiators 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 (2). 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, 2017 which are actively testing BPCI in Phase 2 at one or more episode-initiating sites:

  • Lancaster General Hospital (Lancaster, PA)
  • Methodist Hospital of Southern California (Arcadia, CA)

* 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.

Additional Information