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BPCI Advanced Participation Decisions in March 2019

BPCI Advanced Participation Decisions in March 2019

Monday, March 25, 2019 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment, Hospitals

Last August CMS provided a one-time retroactive opportunity to withdraw in total from the BPCI Advanced program or withdraw selected clinical episodes by March 1, 2019. This grace period allowed participants to “test the waters” between October 2018 and February 2019 before making a final decision. Participants that retroactively withdraw in total or for select clinical episodes are not held accountable for those episodes, meaning that any losses incurred relative to the established target prices will not be charged to the bundler.

CMS recently released a list of BPCI Advanced participants that decided to continue with the program. The information provided by CMS showed that 715 of the 832 acute care hospitals (86%) that went forward with the program in October decided to continue. Also, 580 of the 715 physician groups (81%) that went forward in October decided to continue.

Hospitals and physician groups that continue with the program after March were allowed to “prune” their initial episode selection. On average, hospitals dropped 30% of their originally selected bundles and physician groups withdrew from 28% of their bundles.

Hospitals primarily withdrew from the outpatient bundles. About 82% of hospitals that initially selected outpatient cardiac defibrillator episodes withdrew those bundles. Hospitals also withdrew from outpatient back and neck procedures and outpatient PCI procedures at a rate of 62% and 53% respectively. Inpatient bundles that were dropped the most were cardiac valve procedures (70%), cardiac defibrillator (65%) and major bowel procedures (53%).  The episode groups that were least dropped by hospitals were AMI (19%), CHF (17%), and cardiac arrhythmia (17%). 

More than half of all physician groups that initially selected lower extremity double joint replacement procedures and combined anterior posterior spinal fusion procedures withdrew those bundles. Physician groups were least likely to drop lower extremity joint replacement procedures (only 13% withdrew). Unlike hospitals, physician groups were least likely to drop outpatient cardiac defibrillator (18%) and outpatient PCI procedures (16%).

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