Bundled Payments for Care Improvement Initiative

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Bundled Payments for Care Improvement Initiative

Bundled Payments for Care Improvement Initiative

Ella Clayton

            The Bundled Payments for Care Improvement (BPCI) initiative consists of four broad models of care that all link payments for the multiple services beneficiaries receive during an episode of care. Under the BPCI, organizations go into payment agreements with financial and performance accountability. The purpose of this model is to provide higher quality and more coordinated care at a much lower cost to Medicare.

            The BCPI was developed by the Center for Medicare and Medicaid Innovation. The Innovation center was made by the Affordable Care Act to create effective payment and service delivery models that can potentially reduce Medicare, or Medicaid expenditures while also preserving the quality of care. 

            Model one of the BCPI is the inpatient stay in an acute care hospital. Medicare pays the hospital a discounted amount based on payment rates and continues to pay physicians separately for their services.

            Model two and model three involve a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care. Medicare continues to make Fee for Service payments to providers and suppliers giving services to beneficiaries. The total expenditures for a beneficiary’s episode are later compared against a bundled payment amount. A payment is then made by Medicare.

            Model four consists of Medicare or Medicaid making a single determined bundled payment to the hospital that factor in all services given by the hospital, physicians, and other practitioners during the entire inpatient stay.

            Vertis Therapy partners with our customers in their Bundled Payment Initiative through Clinical Pathways, a service model that supports quality care, and physician communication systems including outcomes reports which coordinate care throughout the patient’s length of stay.