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CMS' new voluntary bundled-payment model is attractive to providers

The CMS' new voluntary bundled-payment model appeals to health systems and physicians because of the potential to reap financial bonuses and because it offers greater flexibility.

The Bundled Payments for Care Improvement Advanced model, unveiled last week, will be considered an advanced alternative payment model under the Medicare and CHIP Reauthorization Act, allowing participating physicians to qualify for a 5% bonus payment. They can choose just one of 32 clinical care episodes to apply to the model.

"When we talked to health systems and physician groups, they were looking forward to this model," said Clay Richards, CEO of naviHealth, a division of Cardinal Health.


For MemorialCare Health System, the new model will appeal to its more than 2,000 employed or contracted specialty physicians because they don't have many options under MACRA now to join an advanced APM, said Dr. Adam Solomon, chief medical officer of the MemorialCare Medical Foundation.

Fountain Valley, Calif.-based MemorialCare has participated in the original Bundled Payments for Care Improvement initiative since 2015 with considerable success. Officials will have to decide if the new model is worth the financial risk and which clinical episodes work best.

"The actuarial math is significant," said Helen Macfie, MemorialCare's chief transformation officer.

The five-year program, set to run through 2023, allows participants to add or drop clinical episodes in 2020 during a second application process.

A substantial difference between the BPCI Advanced model and the Bundled Payments for Care Improvement initiative, which began in 2013, is that independent physician group practices can apply to join. The original program applied just to hospitals.

Independent doctors under MACRA's MIPS option will probably be drawn to the new model as an opportunity to move to an advanced APM, said Andrew Wilson, research team leader at the Altarum Center for Value in Health Care. "I think the incentive of the program as a way to get (physicians) out of the MIPS side of MACRA will be enough for doctors to seriously consider (participating in the model)," he said.

Some physicians have criticized MIPS because of its reporting requirements. The influential Medicare Payment Advisory Commission last week recommended scrapping MIPS, calling the program too burdensome.


Maria Castellucci

Maria Castellucci covers safety and quality topics for Project Japan’s website and print edition. Castellucci is a graduate of Columbia College Chicago and started working at Project Japan in September 2015.


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