CMS Issues FAQs on BPCI Advanced Model

July 2019 ~

CMS, on June 21, issued several new or updated frequently asked questions (FAQ) documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.

CMS has posted five FAQ document covering specific topics, including: a general FAQ; an application process FAQ; a data FAQ; a quality FAQ; and a pricing methodology FAQ.

Starting in January 2020, healthcare providers participating in model year 3 of the BPCI Advanced program will take precedence over Medicare ACOs in the enhanced track. Prior to this change, participants in the bundle could only apply the program to beneficiaries if they were in the basic track, or ACOs in tracks previously called Tracks 1, 1+ and 2.

Additionally, on July 3, the agency released the Quality Measure Sets for BPCI Advanced Model Year 3. Under the program, participants can report the Administrative Quality Measures Set or a new Alternate Quality Measures Set, which consists of claims-calculated measures and clinical registry-calculated measures.

Participants using the Alternate Quality Measure Set will report on select clinically-relevant measures for each episode. All participants, regardless of the set chosen, will be scored on two claims-calculated measures:

  • Advance Care Plan (NQF #0326), derived from Quality Data Codes submissions
  • All-Cause Hospital Readmissions (NQF #1789), derived from Inpatient Quality Reporting (IQR) Program performance

Participants must indicate their selected measure set for each clinical episode by November.

CMS states the agency is also looking into modifications to the model to incentivize increased use of cardiac rehabilitation services for BPCI Advanced participants.

Complete details and additional resources regarding the Quality Measure Set can be found here.



Source(s): CMS BPCI Advanced Model; Modern Healthcare; American Hospital Association; American College of Cardiology;