In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative. There were 4 models included in the program:
- Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment.
- Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post acute care.
- Model 3: includes only post acute care in the bundle,
- Model 4 includes both the index hospitalization and any readmissions.
Most providers elected to participate in Model 2. Further, the number of providers participating in model 2 increased by 3 fold between October 2013 and June 2014. On the other hand, the number of provider group participating in model one was low and remained low and the number participating in model 4 actually declined. Further, physician practices—especially orthopedic practices—have increasing interest in the program, as evidenced by the rising number of physician practices in the BPCI’s non–risk-bearing phase.
Who are the participants in the BPCI program? According to a paper by Chen, Meara and Birkmeyer (2015):
…these [BPCI-participating] hospitals are more likely to be large (500 beds or more)and to be teaching hospitals. Hospitals in the northeast are substantially overrepresented, while those in the south are underrepresented. Participating hospitals are also more likely to be nonprofit than their eligible nonparticipating peers.
Although participants could include up to 48 conditions in their BPCI bundle, most elected to begin the program focusing on only one or two conditions, typically orthopedic or cardiac conditions.
- Lena M. Chen, MD, MS; Ellen Meara, PhD; and John D. Birkmeyer, MD. Medicare’s Bundled Payments for Care Improvement Initiative: Expanding Enrollment Suggests Potential for Large Impact. AJMC. November 13, 2015.