Modification to the Start of BPCI Advanced

Modification to the Start of BPCI Advanced

Tuesday, July 17, 2018 | by Randy Haught

Tags: BPCI Advanced, Bundled Payment


The BPCI Advanced program is scheduled to begin on October 1, 2018. Initially, hospital and physician group practice applicants were to make a decision by August 1, 2018 as to whether to participate in the program and to select clinical episode groups in which to participate. It was important that applicants quickly and carefully assess information provided by CMS in order to make sound decisions about their level of participation because participants would be locked into this decision for 15 months. Meaning that they cannot add or withdraw clinical episode groups, except upon request by CMS, until January 2020.

However, CMS has recently pushed back that decision date to August 8th. In addition, due to requests from applicants for a later start date, CMS is providing a one-time retroactive opportunity to withdraw in total from the program or withdraw selected clinical episodes in March 2019. This grace period will allow 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 will not be held accountable for those episodes. Meaning that any losses incurred relative to the established target prices will not be charged to the bundler.

This newly announced grace period should relieve some of the anxiety for potential bundlers regarding the need to make a hasty decision on whether to participate and what clinical episodes to select. It also provides a great opportunity to participate in a broad range of clinical episodes in order to test care redesigns, collect data, and monitor performance. In February, bundlers can then decide which clinical episodes will work best for them over the long term and then withdraw from the others with no financial penalty.      


For more information please contact Randy Haught at         


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