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Participation agreements for the Bundled Payments for Care Improvement (BPCI) Advanced program from CMS were due recently, and providers are going live with the program on Oct. 1. In a new twist from old versions of BPCI, CMS has issued an option for providers to retrospectively drop out of the program in March 2019, notes Keely Macmillan, BPCI general manager with Archway Health, a software company in Watertown, MA.
(More information on BPCI Advanced is available on the CMS website at: https://bit.ly/2mcB3me.)
“It was a tight time frame to begin with as far as when you got the data and when you had to get your agreement in for participation, but on top of that there were some providers who got their data quite late,” she says.
“There also were some errors with some of the data that affected particular bundles, so CMS added this option to drop out without a penalty if it looks like the program is not going to benefit you.”
That option applies to any participating providers, Macmillan notes, not just those who received incorrect or late data.
“For those providers who were a little more reluctant to enter the program because perhaps they had a higher risk, this option for leaving later might have made them more willing to participate,” she says.
“Generally, this is a good thing because it gives providers a chance to get their feet wet in the program for several months, after which they should have more data and can make a better decision about whether to stay in the program or not. They also can decide to pick and choose certain bundles to drop in March.”
Macmillan notes, however, that those participating providers need to have the proper tools in place to monitor their risk before that March deadline.
CMS has stated that it will flag patients attributed to an accountable care organization, an important distinction that providers must watch for as the program moves forward, Macmillan says.
“This is about making an informed decision once the program has begun, and providers need to be prepared to monitor this data so they can make the right call in March about whether to continue,” she says.
Financial Disclosure: Author Greg Freeman, Editor Jesse Saffron, Editor Jill Drachenberg, Nurse Planner Jill Winkler, Editorial Group Manager Terrey L. Hatcher, and Consulting Editor Patrice Spath report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.