The Centers for Medicare & Medicaid Services (CMS) has recently decided to cancel two of their different payment models. These models were previously considered mandatory. The CMS also scaled back one of their other payment models. These payment models were removed or changed to streamline the overall payment process.
The goal of these changes is to help providers make the switch from a fee-for-service model to a bundled payment model based on value.
To help make the process faster, CMS has introduced the Bundled Payments for Care Improvement Initiative (BPCI). This initiative will last through September 2018 and includes a good number of doctors. When it expires, it will have helped many doctors and medical centers make a move to a value-based payment system. But how exactly will this work, and how will it affect healthcare providers?
A Breakdown of the Changes
The first change to note is the cancellation of several different bundled payment models: the cardiac model and the hip replacement model. These two bundled payment models were mandatory before their cancellation. The CMS also canceled the planned implementation of two new bundled payment models. The Episode Payment Model and the Cardiac Rehabilitation Incentive model were to go into effect on January 1, 2018, but that is no longer the case.
The Comprehensive Care for Joint Replacement Model is also being scaled back. Previously, 67 geographical areas were required to make use of this model, but the CMS has reduced that number to 34.
However, some new bundles are being added, including outpatient bundles. These bundles are designed to help bring in more patients. Previously, payment bundles only covered inpatient care. Another change will be how these bundles are priced and how risk adjustment is determined. The changes made under the BPCI won’t be as simple as those currently being used. This will make them more flexible and will provide bundles for more participants.
How the BPCI Will Affect Providers
After years of looking at payment bundles, the CMS designed the BPCI to keep what has been working well and change what hasn’t. The result will be a model in which more providers can participate. More doctors, specialists, and others will find that the changes made suit them better than the older model. Part of this is that it’s easier to understand how providers can produce revenue using the new bundled payments. This has been one area that many providers have found unclear before, leading to them avoiding bundled payment models completely.
Another change is the focus of the BPCI. Previously, it had been aimed mainly at hospitals. The creation of the Medicare Access and CHIP Reauthorization Act, better known as MACRA, is aimed at physicians. However, these physicians can only make use of MACRA if they comply with the BPCI. This is designed to help remove some of the payment methods that aren’t as appealing to consumers, including the Merit-Based Incentive Payment System (MIPS).
Prior to these changes, many specialists were unable to make use of the Alternative Payment Model (API) offered through MACRA. Thanks to the changes made in this version of the BPCI, however, specialists do qualify. This is something that the CMS has been pressured to change for quite some time.
The End Result
While it’s true that the CMS is removing some of their bundled payments, they aren’t scraping that model altogether. Instead, medical bundlers are looking at ways that make the process better. The changes they have made to the BPCI will help providers make the jump to a value-based payment model. This transition will help specialists, and other physicians make use of the program. It will also let these providers and their patients take advantage of available cost savings.
The level of care will also increase under the new BPCI. Now, hospitals, physicians, and specialists will be able to look at a wide variety of information to determine how they can improve their payment models. This, in turn, will allow them to offer care to those who may not have been able to afford it before. For providers who have been unable to make use of the old BPCI, this newer version aims to include them. It’s a good fit for many healthcare providers.
Healthcare providers do have to state that they plan to participate in this new version of the BPCI. However, the CMS does expect many will quickly agree to the initiative due to the beneficial changes that have been added and the removal of models that many providers found unhelpful. The healthcare industry is still focused on the idea of offering value-based healthcare through bundled payment plans, and this upgraded version of the BPCI shows the CMS’s commitment to that model.