On Tuesday, the Centers for Medicare & Medicaid Services (CMS) hosted an “Open Door Forum” webinar for providers interested in the newly announced Bundled Payments for Care Improvement Advanced (BPCI Advanced). This is a new, voluntary advanced payment model to test iterations of bundled payments for episodes of care including major joint replacement of the lower extremity. At the Q&A forum, CMS clarified some issues relevant to AAHKS. Read the summary from our legislative firm Epstein Becker & Green, P.C.:

  • Successful applicants to BPCI Advanced, who are also participating in Comprehensive Care for Joint Replacement (CJR) program, will not be permitted to participate in BPCI Advanced for the same joint replacement episodes included in CJR.
  • Clinical episodes triggered under the CJR model will take precedence over those in BPCI Advanced.
  • Elective joint replacement and hip fracture surgery will have one target price.
  • CMS does not plan to add outpatient major joint replacement of lower extremity as a BPCI Advanced clinical episode.

Many questions were left unanswered. CMS acknowledged issues surrounding TKA’s removal from the inpatient only list (IPO), and the agency is still developing a BPCI Advanced pricing policy that will account for the IPO change. CMS explained that they will communicate the policy as soon as feasible.

Target prices under BPCI Advanced are still forthcoming but will be based on patient characteristics and historical data. In view of this, BPCI Advanced will allow model conveners and non-conveners to leave the model at any time, subject to the terms of the participation agreement. Additionally, a hospital or physician group practice will be allowed to apply for BPCI-Advanced in 2020 even if it did not apply in 2018.

An additional Q&A forum will be held on February 15, 2018 at 12:00 p.m. (EST) where CMS may address some of these unanswered questions. EBG will attend and provide a summary.