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News & Press: Government Affairs News

CMS Releases BPCI Advanced

Tuesday, January 9, 2018   (0 Comments)
Posted by: Bradley Coffey, MA, AAOE Government Affairs
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Baltimore, MD - The Centers for Medicare and Medicaid Services (CMS) has released the second iteration of the popular Bundled Payments for Care Improvement (BPCI). Created by the Center for Medicare and Medicaid Innovation (CMMI), BPCI Advanced will be a voluntary, retrospective bundled payment model for 32 clinical episodes. The new model will qualify as an Advanced Alternative Payment Model (A-APM) under the Quality Payment Program.

According to CMS, the first cohort of BPCI participants will begin participation in the model on October 1, 2018 with participation lasting through December 31, 2023. A second cohort will begin participation in October 2020 following an application period beginning in January 2020.

BPCI Advanced will consist of the following characteristics:

  • Voluntary;
  • Single retrospective bundled payment and one risk track, with a 90-day clinical episode duration
  • 29 inpatient clinical episodes
  • 3 outpatient clinical episodes
  • Advanced APM
  • Payment is tied to performance on quality measures
  • Preliminary target prices will be provided in advance of the first performance period of each model year

BPCI Advanced, like the current BPCI, will require participants to bear downside financial risk, and participants will be eligible to participate either as a non-convener participant or as a convener participant. Acute care hospitals and physician group practices are eligible to participate in the model as non-convener participants. A non-convener participant is a participant that does not bear financial risk on behalf of other participants. Eligible enrolled entities that are Medicare-enrolled providers or suppliers, eligible entities that are not enrolled in Medicare, acute care hospitals, and physician group practices are eligible to participate as convener participants. Convener participants bring together multiple episode initiators (termed downstream entities by CMS) and coordinates participation and bears and apportions financial risk under the model.

Clinical Episodes

Clinical episodes in BPCI Advanced will be attributed at the episode initiator level and will begin either at the start of an inpatient admission to an acute care hospital or at the start of the outpatient procedure. Inpatient triggers will be identified by the appropriate MS-DRG while outpatient triggers will be identified by the appropriate HCPCS code. The clinical episode will end 90 days after the trigger event (either admission or procedure).

Clinical episode selections will be due to CMS by August 2018. The previous iteration of BPCI has included total knee and total hip replacements in the clinical episodes and it is highly likely they will be included in the new model.

Payment for episodes will be for costs associated with the initial trigger event and post acute care for 90 days including physician services, inpatient and outpatient services comprising the initial trigger event, other hospital outpatient services, hospital readmissions, long-term care hospital (LTCH) services, inpatient rehabilitation facility (IRF) services, skilled nursing facility (SNF) services, home health agency (HHA) services, durable medical equipment, Part B drugs, and hospice services.

Clinical episodes included in the model are:


  • Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis (New episode added to BPCI Advanced)
  • Acute myocardial infarction
  • Back & neck except spinal fusion
  • Cardiac arrhythmia
  • Cardiac defibrillator
  • Cardiac valve
  • Cellulitis
  • Cervical spinal fusion
  • COPD, bronchitis, asthma
  • Combined anterior posterior spinal fusion
  • Congestive heart failure
  • Coronary artery bypass graft
  • Double joint replacement of the lower extremity
  • Fractures of the femur and hip or pelvis
  • Gastrointestinal hemorrhage
  • Gastrointestinal obstruction
  • Hip & femur procedures except major joint
  • Lower extremity/humerus procedure except hip, foot, femur
  • Major bowel procedure
  • Major joint replacement of the lower extremity
  • Major joint replacement of the upper extremity
  • Pacemaker
  • Percutaneous coronary intervention
  • Renal failure
  • Sepsis
  • Simple pneumonia and respiratory infections
  • Spinal fusion (non-cervical)
  • Stroke
  • Urinary tract infection


  • Percutaneous Coronary Intervention (PCI)
  • Cardiac Defibrillator
  • Back & Neck except Spinal Fusion

Quality Measures

Reimbursement in BPCI Advanced, like its predecessor, will in part be based on performance on certain quality measures. The seven measures listed below have been selected by CMS for the new model. The first two measures listed will be required for all clinical episodes while the five after will only be required for select clinical episodes.

  • All-cause Hospital Readmission Measure (NQF #1789)
  • Advanced Care Plan (NQF #0326)
  • Perioperative Care: Selection of Prophylactic Antibiotic: First or Second Generation Cephalosporin (NQF #0268)
  • Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) (NQF #1550)
  • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Coronary Artery Bypass Graft Surgery (NQF #2558)
  • Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction (NQF #2881)
  • AHRQ Patient Safety Indicators (PSI 90)


Applications to participate will be accepted January 11 through March 12, 2018 and must be submitted via the BPCI Advanced Application Portal.

An application template and other materials are available below:

For more information, look for AAOE education related to the new model and read the BPCI Advanced Request for Applications.

CMS will be hosting an open door forum on the new model on January 30, 2018. Register here.

To see a timeline of the first application period, click the image below:


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