6-Month, No-Risk Period: Fresh Insights from HDG on Bundled Payments for Care Improvement

Posted on July 17, 2018 by Jodi Boyne

With the next round of Bundled Payments for Care Improvement (BCPI) about to begin, Health Dimensions Group (HDG) reviews some potentially game-changing program modifications that will likely increase participation in the next round of voluntary bundling. 

In a recent blog post, Brian Ellsworth, HDG Vice President of Public Policy and Payment Transformation, reviews two key changes: 

The first change is a one-week reprieve on the deadline for decisions by hospitals and physician group practices on whether to participate in BPCI Advanced and, if so, for which clinical categories. The new deadline is Aug. 8. 

The second change could create new opportunities for post-acute care providers. CMS modified the 15-month lock-in requirement for participation decisions in BPCI Advanced. Hospitals and physician group practices that applied for BPCI Advanced will now have a one-time-only option to withdraw some or all of their selected clinical episodes (diagnostic categories) in March 2019, retroactive to the Oct. 1, 2018 start date. This flexibility was added due to CMS delays in getting claims data and target prices to bundlers. Importantly, all other program requirements remain in place. 

According to HDG, many bundlers were agonizing about participation and weighing the effect of the 15-month clinical episode lock-in requirement prior to this modification. Now bundlers have little reason not to move forward with all the diagnostic categories that they have been considering. CMS has effectively created a six-month, upside-only risk arrangement for BPCI Advanced. 

Want to learn how these changes may affect your organization? Read BPCI Advanced Policies Modified to Significantly Increase Participation: Program Will Now Have a Six-Month No-Risk Period on the Front End.