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CMS Announces New Bundled Payment Model to Qualify as an Advanced APM; No Ophthalmic Procedures or Conditions Included

This week, CMS announced a new episode-based payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced), that will qualify as an Advanced Alternative Payment Model (APM) under MACRA beginning in October 2018. BPCI Advanced is a modified version of a previous model proposed under the Obama administration that was withdrawn by the Trump administration. Similar to the previous model, BPCI Advanced provides a single bundled payment for an episode of care, incorporating all costs under Medicare Parts A and B. The modified BPCI Advanced is now a voluntary model that incorporates physician involvement and management, whereas the previous model was mandatory and hospital-based. BPCI Advanced also includes a limited list of 32 procedural and conditions based episodes, reduced from a previous list of 48 episodes. Twenty-nine episodes are inpatient, and three are outpatient; none include any ophthalmic procedures or conditions. While this model does not currently include any ophthalmic procedures, current efforts to develop episode-based cost measures, such as for cataract surgery, may be incorporated into a bundled payment APM in future years. We will keep you updated.