Advanced Bundled Payment Model Reduced Payments for High-Risk Patients

Hospital participation in Medicare’s Bundled Payment for Care Improvement Advanced Model (BPCI-A) decreased Medicare payments and did not negatively impact health outcomes for high-risk patients, a Health Affairs study found.

CMS launched the BPCI-A in October 2018 as a voluntary Alternative Payment Model (APM) in which hospitals are held accountable for the costs and outcomes of 90-day episodes of care. The model has been associated with reductions in Medicare payments per episode and improved clinical outcomes.

However, hospitals must either decrease utilization or attract a less sick patient population to meet spending targets, raising concern about the model’s impact on patients with substantial healthcare needs.