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The U.S. Centers for Medicare and Medicaid Services (CMS) announced that it has stretched out the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model for an additional two years. While the program isn’t home health focused, it’s an opportunity for providers to collaborate with acute care hospitals, physician group practices and other Medicare-certified entities.
The program originally launched in 2018, and was slated to wrap up on Dec. 31, 2023. Now, the program is now scheduled to end Dec. 31, 2025.
The BPCI Advanced model is an Advanced Alternative Payment Model (AAPM) that is part of the Quality Care Program.
Broadly, the idea behind the BPCI Advanced model is to give acute care hospitals and physician group practices opportunities to voluntarily bear risk on Medicare fee-for-service patients during their 90-day episode of care. This model is administered through the Center for Medicare & Medicaid Innovation (CMMI).
Overall, the goal is to encourage care coordination, activate practice care innovation, lower expenditures and improve the quality of care.
The two year extension of the BPCI Advanced model by CMS was unexpected, Michael Wolford, principal at the public accounting firm Forvis, told Home Health Care News.
“It was definitely a surprise,” he said. “Perhaps the even more surprising part is that they are allowing new participants or previously enrolled participants that are no longer actively enrolled, to reapply for 2024 and 2025.”
Indeed, as part of the extension, CMS opened the program to new applicants. Early next year, CMS will announce a request for applications for Medicare Accountable Care Organizations (ACOs) and other Medicare-certified entities.
From a home health care standpoint, the extension of the model – and new application periods – allows them another possible entry into risk-based models.
Plus, for home health providers interested in developing relationships with organizations participating in the program, this could be a positive development.
“Home health — or any other type of post acute provider — can be an informal collaborator with the acute care hospitals for which patients are being discharged or with the physician group practices that are initiating episodes,” Wolford said. “By collaborators, I mean working together for the patient’s best interests and appropriately sharing clinical data.”
There are also more formal ways for home health providers to get involved.
“They can be involved in formal alignment agreements with participants that could take a variety of forms, and those could be financial, those could be participatory, those could be any number of things,” Wolford said.
Home health providers occupy a unique position that allows them to be a value-add in partnerships with other health care organizations.
“Home health tends to be a lower cost post-discharge setting for Medicare patients,” Wolford said. “Providers with financial incentives that exist in the BPCI Advanced model often look for a combination of clinical efficacy, successful patient outcomes and cost-effectiveness of care. Home Health tends to rise to the top in those situations.”
One in-home care provider that has already leaned into BPCI Advanced is Healing Hands Healthcare.
“We had the opportunity to partner in a BPCI bundle, and had a very pleasant experience,” Healing Hands CEO Summer Napier told HHCN. “We worked with an amazing Orthopedic Group, and had a 99% success rate of keeping patients out of the hospital on this bundle while they were on home health services.”
Wichita Falls, Texas-based Healing Hands is a for-profit in-home care provider that serves 22 counties in Texas. Its service offerings range from skilled nursing care and therapy services, to medical license social working and private-duty home care.
Napier views these collaborations as an opportunity for home health providers to form partnerships that span across the care continuum.
While Healing Hands experience was extremely positive, Napier warns home health providers to step into these partnerships with awareness, and make sure they’re the right fit.
“If you don’t understand the BPCI model and what you’re signing up for, you can lose on things that are outside of your control,” she said. “Let’s say you take total risk, and you want to have a higher risk for a higher reward mindset. If you don’t have a great relationship with those physicians, and you don’t have the ability to tell them the importance of having certain visits at certain times … they can ruin the whole thing.”
In the future, Healing Hands is open to the opportunity to collaborate with more of the program’s participants.
“Overall, it was an exceptional experience,” Napier said. “We would love the opportunity and do have plans to continue those partnerships in different areas. [Home health providers] need to get out there and try new things, we need to be innovative and strategic in bringing health care home. This model is, like many of the others, an opportunity to do that.”
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