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CMS Announces Extension, Changes to BPCI Advanced Model

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The Centers for Medicare & Medicaid Services (CMS) has announced the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model will be extended for two years. The BPCI Advanced Model will now end on Dec. 31, 2025.  

The two-year extension will include a new application opportunity and CMS plans to announce a request for applications in early 2023 for Medicare-enrolled providers and suppliers and Medicare accountable care organizations (ACOs) to participate in the model’s two-year extension (2024-25).  

To be eligible for participation in the extension, convener applicants must be Medicare-enrolled entities or ACOs. Existing convener participants will be permitted to remain in the BPCI Advanced Model during the extension years, and acute care hospitals (ACHs) and physician group practices (PGPs) may join existing convener participants as downstream episode initiators (EIs) during this period. Those interested in applying as non-convener applicants will need to be an ACH or a PGP. 

Both convener participants and non-convener participants active during Model Year 6 (2023) will have the opportunity to continue participating in the model by signing an Amended and Restated Participation Agreement for Model Year 7 (2024). EIs (ACHs or PGPs) that previously participated in the model, but are no longer active, will also have the opportunity to apply for Model Year 7 (2024).  

CMS will also implement the following changes to improve the pricing methodology and keep providers and suppliers engaged in value-based care through the BPCI Advanced Model in Model Year 6 (2023): 

  • Reduce the CMS discount for medical clinical episodes from 3% to 2% 
  • Reduce the peer group trend factor adjustment cap for all clinical episodes from 10% to 5% 
  • Make major joint replacement of the upper extremity a multi-setting clinical episode category by including outpatient total shoulder arthroplasty procedures (triggered by Healthcare Common Procedure Coding System 23472) in the model. CMS will also include a trauma/fracture flag and major joint replacement of the upper extremity procedure group flag along with their interactions in the risk adjustment for this clinical episode. 
  • Hold participants accountable for all clinical episodes in which the beneficiary has a COVID-19 diagnosis during the clinical episode 

More information is available in a CMS fact sheet.