CMS Bundled Payments for Care Improvement Initiative Models 2-4 Report Released

The second Annual Report recently released, provides a summative and formative evaluation of the Center for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative Models 2-4 and is based on the multiple evaluation and monitoring activities completed during the second year of the evaluation. The report reflects quantitative analyses of Phase 2 participants that joined the initiative during the first year (Q4 2013 – Q3 2014) and qualitative analyses of participants that joined during the first seven quarters (Q4 2013 – Q2 2015). Most results are based on the experience of 94 Awardees across three Models, with 227 episode initiators (EI) that were responsible for 58,410 episodes of care during the first year of the initiative. The EIs comprised 130 acute care hospitals, 63 skilled nursing facilities, 28 home health agencies, four physician group practices, one inpatient rehabilitation facility, and one long-term care hospital. Participation in BPCI has continued to grow with many more providers entering Phase 2 in Q2 2015 and Q3 2015, and more EIs transitioning episodes to Phase 2 which will be covered in the next (third) Annual Report.

The three BPCI Models evaluated in this report vary as to the bundle definition and payment approach. The bundle is defined as the services provided during the episode that are linked for payment purposes.

• Model 2 has the most comprehensive bundle, which includes the triggering hospital stay (i.e., the anchor hospitalization), all concurrent professional services and post-discharge services, including hospital readmissions, delivered within the chosen episode length of 30, 60, or 90 days (with certain exclusions). Individual providers are paid on a fee-for service basis and total episode payments are reconciled retrospectively against the established target price.
• The Model 3 bundle includes services after the anchor hospital discharge, including professional services and readmissions within the chosen episode length of 30, 60, or 90 days (with certain exclusions). The episode starts when a beneficiary is admitted to a participating skilled nursing facility (SNF), home health agency (HHA), inpatient rehabilitation facility (IRF), or long-term care hospital (LTCH) following a hospitalization for a chosen clinical episode, or when a beneficiary is admitted to a postacute care (PAC) setting by a physician who is in a participating physician group practice (PGP). Individual providers are paid on a fee-for-service basis and total episode payments are reconciled retrospectively against the established target price.
• The Model 4 bundle includes the anchor hospitalization, all concurrent professional services, and any readmissions and associated professional services that occur within 30 days of discharge that are not explicitly excluded from the bundle. Awardees are paid a prospectively determined amount and they, in turn, pay the providers involved in the episode.

To read the full report click here.