Given CMS provided participants a “risk-free trial period,” it isn’t unexpected to see the total number of episodes decline.

HFMA reported March 21: “One in seven providers in the largest Medicare bundled payment model left after five months, new data reveal. But that may be good news for the program.”

The Centers for Medicare & Medicaid Services (CMS) disclosed that 117 hospitals (14 percent) and 135 physician practices (19 percent) left Medicare’s Bundled Payments for Care Improvement Advanced (BPCI-A) program by March 1.

As part of the five-year payment model, the 1,299 hospitals and practices that joined for the Oct. 1, 2018, launch had a one-time opportunity to drop out at the beginning of this month for any reason.

BPCI Advanced “continues to have robust participation with approximately 84 percent of participants remaining in the model,” a CMS spokesman said. “We did this based upon stakeholder feedback so that participants would have the ability to experience the model before making a final decision.”

Providers that volunteered to participate in BPCI-A face two-sided risk in managing all spending compared to a specified target for episodes of care within any of 32 clinical bundles. Quality measures are factored in, as well.

Karen Joynt Maddox, M.D., an assistant professor at the Washington University School of Medicine, who has studied bundled-payment models, said the departures were fewer than she anticipated.”

The entire article, “More Than 15 Percent of Providers Depart BPCI Advanced,” is available for review on the website.


Given CMS provided participants a “risk-free trial period,” it isn’t unexpected to see the total number of episodes, or average number of episodes per participant, decline. Many participants saw this as an opportunity to undertake “stretch” episodes. Stretch episodes are ones where the savings would be more difficult to achieve. They typically are aligned with the organization’s quality improvement goals. Under this strategy, organizations could determine whether to continue participation based on early efforts to re-engineer care delivery because they wouldn’t have meaningful episode claims experience even if CMS had delivered the data in a timely manner. The number of hospitals participating in the program dropped 14 percent while the number of physician practices dropped 19 percent. The larger attrition of physician practices may signal their discomfort with taking risk given the challenges that CMS has had to date providing participants with claims data.

Chad Mulvany is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office, and a member of HFMA’s Virginia-Washington, D.C., Chapter. 

Publication Date: Tuesday, March 26, 2019