New CMS bundled payment model introduces outpatient episodes

Why This Topic Matters

BPCI Advanced affects how Medicare bundled payments are structured and reported for selected clinical episodes. Understanding the model’s scope, participant types, and quality reporting framework helps organizations assess whether the program is relevant to their operations and readiness for alternative payment arrangements.

Article Sections

1. Existing BPCI models

   Summarizes the earlier bundled payment models and their general structure. The section provides context for how the prior program differs from the newer model.

2. BPCI vs. BPCI Advanced

   Compares the earlier program with the newer CMS model at a broad level. It outlines the major changes in scope, payment approach, and program status.

3. Participation

   Describes who CMS is seeking to participate and the general participant categories in the model. It also notes the types of organizational capabilities highlighted in the application materials.

4. Clinical episodes

   Explains the episode framework used in the program and identifies the broad categories of inpatient and outpatient episodes. It also discusses how episodes are anchored and the general types of services considered.

5. Payment calculations

   Introduces the basic payment methodology used in the model and how reconciliation is described. The section covers the overall calculation framework at a high level.

6. Quality measures

   Lists the categories of quality measures associated with the model and indicates that some apply broadly while others are episode-specific. It provides a high-level view of the reporting framework.

7. What’s next

   Notes the application timing and points readers to additional CMS resources. It serves as a closing section for next steps and further information.