Tweaks to Bundled Payment Model Open Up New Skilled Nursing Opportunities

The Centers for Medicare & Medicaid Services (CMS) made some tweaks to the most recent bundled payments program that could boost participation by hospitals and physician groups — and skilled nursing providers should be ready, one expert told Skilled Nursing News.

The Bundled Payments for Care Improvement Advanced (BPCI Advanced) initiative was first announced in January; participants can receive payments for 32 clinical episodes of care, including major joint replacement and a coronary intervention. While SNFs and home health agencies can participate in the bundles, they cannot be episode initiators.

Earlier this month, CMS announced some modifications to the program — two of which are “potentially game-changing,” Brian Ellsworth, vice president of public policy and payment transformation at the consulting firm Health Dimensions Group (HDG), wrote in a blog post on July 12.


The first is that CMS moved the deadline for participation decisions by hospitals and physician group practices (PGPs) up by one week to Aug. 8, as reflected in an updated BPCI Advanced timeline from CMS.

The second is a modification to the 15-month lock-in requirement for those participation decisions. CMS initially planned to have participants stay in the program from October 1 of this year until December 31, 2019. Now, however, hospitals and PGPs have “a one-time only option” to withdraw some or all of their clinical episodes in March 2019.

“The practical effect of all that is it basically gives folks a chance to decide to participate and, if so, to see how things are going,” Ellsworth told SNN. “If things aren’t working out, they can withdraw …  so basically anyone that is kind of wavering can now kind of jump in without fear of being locked into position for 15 months.”


The changes came about because CMS had delays in getting the target price and claims data to program applicants, he explained. And in making the changes, participation in the BPCI Advanced program could well end up increasing, especially from PGPs and hospitals that might have hesitated to join because of the 15-month lock-in, Ellsworth said.

“Having said that, the basic structure of the program is that you’re still kind of locked in the sense that you can only withdraw next March,” he noted. “You can’t add or tweak things, and so if you elect to participate, you still need kind of an effective care redesign and an effective structure in order to succeed.”

That’s where SNFs have an opportunity. Hospitals and PGPs should consider risk-sharing partnerships with post-acute providers, Ellsworth stressed in his blog post, because bundlers will need partners with well-aligned incentives on both quality and cost.

“Skilled nursing providers need to knock on doors to find out who’s considering participating and start that dialogue now if they haven’t already,” he told SNN. “Even if they can’t work out a risk-sharing arrangement, they should be having an active conversation with anybody who is considering participation in BPCI Advanced.”

Written by Maggie Flynn

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