- Provider participation in Medicare’s largest voluntary bundled payment program surged by 57% in 2020.
- Physician practice participation rose to match that of hospitals.
- Three new episodes were a big draw in the program.
Participation in Medicare’s leading voluntary bundled payments program surged to more than 2,000 hospitals and practices for 2020.
With the 57% increase from 2019, the Bundled Payments for Care Improvement Advanced (BPCI Advanced) program rose to its largest enrollment level. After launching in October 2018, the program lost 16% of participants last year. Annual participation levels, according to Medicare data, were:
- 1,547 in 2018
- 1,280 in 2019
- 2,015 in 2020
Analyses by Archway Health found other positive 2020 developments for BPCI Advanced, such as an 80% provider retention rate, which was much higher than occurred in the predecessor bundled payment program. Additionally, the number of episodes taken on by each provider, calculated as unique episode and provider combinations, increased by 65% to 12,719. That showed broad interest in a number of the bundle options included in the program, said Keely Macmillan, senior vice president of policy at Archway Health.
Likely reasons why participation jumped, Macmillan said, include:
- Having sufficient time to evaluate the program, compared with a hurried initial enrollment
- Wanting to participate in three of the new bundle options
- Believing this may be among last chances to voluntarily take on risk before CMS mandates it
As part of the five-year payment model, providers face two-sided risk in managing all spending compared with a specified target for episodes of care within any of 35 clinical bundles. Quality measures are factored in as well.
Provider participants in new bundle options included:
- 138 participants in bariatric surgery
- 125 participants in transcatheter aortic valve replacement
- 375 participants in a seizures bundle
Other developments in the program
For 2020, BPCI Advanced became less hospital-focused, with physician practices now comprising 50% of participants. In 2019, 54% were hospitals.
Macmillan said the increasing interest from practices may stem, in part, from pressure on physicians to join advanced alternative payment models (APMs), for which BPCI Advanced meets the criteria. The Medicare Access and CHIP Reauthorization Act of 2015 offers physicians in APMs annual bonuses equal to 5% of their covered Medicare professional services payment through 2024, while non-APM physicians face extensive quality-reporting requirements and potential cuts of up to 9% of their Medicare professional services revenue.
Another noteworthy change for 2020, Macmillan said, was that the perennially popular bundle for major joint replacement of the lower extremity had a slight decrease in the number of providers selecting it, despite the sharp increase in overall model participation. The decrease occurred as Medicare moved the procedures from an inpatient-only classification to outpatient settings.
“With so much change, as far as the patients who would trigger that episode, that’s probably contributing somewhat to the tempered participation in that particular bundle, which historically been very popular,” Macmillan said.
Medicare pricing changes for major joint replacement also likely reduced the attractiveness for providers, she said. Payments have declined in keeping with overall Medicare spending on the procedures.
Lessons learned so far
Success in bundled payments is determined by varying factors, depending on the type of episode on which the model is focused, Macmillan said. But common levers she has seen providers use to achieve success include:
- Reducing readmissions
- Using Medicare data to support approaches
- Using more cost-effective settings for follow-up care
- Increasing upfront planning and patient education
“Patient education across all bundles has been a key lever for improvement in the program, with patients understanding their conditions, their symptoms, symptom management and follow-up care,” Macmillan said.
As far as outcomes, Macmillan remained optimistic that the program will deliver hoped-for savings, even after a recent study found savings declining in recently released results for the predecessor program to BPCI Advanced.
CMS viewed that earlier program as a “sandbox for learning, and they’ve made a lot of changes from BPCI Classic to BPCI Advanced, so you can’t really infer too much from BPCI Classic as far as the results,” Macmillan said. “It’s too soon to tell for BPCI Advanced what those spending trends are, but those are expected to be more reflective of how these alternative payment models can work.”