BPCI Advanced: Quality Measures | CMS Innovation Center

Background

The Bundled Payments for Care Improvement (BPCI) Advanced Model reimburses Participants for clinically appropriate services provided to Medicare beneficiaries throughout an entire clinical episode using a voluntary bundled payment methodology. The Model rewards providers for delivering services more efficiently, supports enhanced care coordination, and recognizes high quality care. BPCI Advanced aims to help hospitals and clinicians work more collaboratively to achieve these goals, which have the potential to improve the beneficiary/patient experience and align to the CMS Quality Strategy goals of promoting effective communication and care coordination, highlighting best practices, and making care safer and more affordable. An overarching goal of the Model is to promote seamless, patient-centered care throughout each clinical episode, regardless of which health care provider(s) is/are responsible for a specific element of that care.

The CMS Innovation Center has engaged extensively with stakeholders to identify more targeted and actionable quality measures that better reflect performance within clinical episodes. In doing so, the Center intends to provide Participants the flexibility to report quality measure performance through either an Administrative Quality Measures Set or an Alternate Quality Measures Set in Model Year 5.

Administrative Quality Measures Set

The Administrative Quality Measures Set, used starting in Model Year 1, contains seven exclusively claims-based measures directly collected by CMS. Three measures, All-cause Hospital Readmission, Advance Care Plan, and the CMS Patient Safety Indicators, will be required for all Clinical Episodes. Up to two additional measures will apply to select Clinical Episodes as applicable.

Alternate Quality Measures Set

The Alternate Quality Measures Set, used starting in Model Year 4, includes a combination of up to five claims-based and registry-based measures for each Clinical Episode. The Alternate Quality Measures Set was developed after CMS gathered information from various stakeholders and established registries to identify a set of tailored quality measures that align with each of the specialty-specific Clinical Episodes in the Model.

Two measures, All-cause Hospital Readmission and Advance Care Plan apply to all Clinical Episodes. Up to three clinically relevant measures will also apply per Clinical Episode as applicable. To minimize Participant burden, the three clinically relevant measures will be derived from a combination of claims, IQR, and a limited number of robust clinical registries that align well with individual Clinical Episode’s registry submission methods.

Quality Measures Set Selection

Episode Initiators will be required to commit to either the Administrative Quality Measures Set or the Alternate Quality Measures Set in advance of participation at the beginning of each Model Year. The established Composite Quality Score (CQS) calculation methodology will apply to both measure sets.

CMS may determine whether additional quality measures should be incorporated into the Administrative Quality Measures Set or the Alternate Quality Measures Set in future Model Years and the quality measures may be updated by CMS on an annual basis.

Additional Information

Quality Measures Resources

Model Year 1, 2, and 3 Administrative Fact Sheets

Model Year 4 Quality Measure Fact Sheets

Model Year 5 Quality Measure Fact Sheets

Participant Resources

Please visit the Participant Resources web page for additional materials for organizations actively participating in the Model.

General Information

Please visit the Additional Resources section on the General Information page for additional materials about the Model.