In order to maintain pace with current and future evolving health care reform, hospital systems are engaging and changing from traditional health care delivery systems to alternative payment models (e.g., creation of accountable care organizations, medical homes, clinical integrated networks, value-based purchasing and advanced alternative payment models-APM). Another option of an APM became a healthcare reform reality on January 9, 2018, as The Center for Medicare and Medicaid Services (CMS), through its Innovation Center, released a new voluntary payment model called Bundled Payments for Care Improvement Advanced (BPCI-A).

On the first night of ACCVPR's Day on the Hill (DOTH) 2018 event, Dr. Stephen Farmer, Senior Advisor and Senior Medical Officer, Center for Medicare and Medicaid Innovation, presented an overview of the BPCI-A to approximately 80 AACVPR participants from 32 states. He highlighted that this payment model was created to build on the lessons from the current voluntary BPCI that will conclude later this year. The BPCI-A model will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program (QPP) in 2018. Within the Medicare Access and CHIP Reauthorization Act (MACRA), Advanced APMs must include three elements:

1. The use of certified electronic health records,
2. The use of quality measures similar with those in the Merit-based Incentive Payment Systems
3. Bear financial risk.

In BPCI-A, 32 distinct clinical episodes are available to model participants. Of those episodes, 29 are inpatient, and are diagnoses that are treated by our specialty of cardiopulmonary rehabilitation (CPR) such as: chronic obstructive pulmonary disease, bronchitis and asthma, CABG, PCI, AMI, heart failure, and cardiac valve. New to this version of BPCI-A are three outpatient clinical episodes, including PCI. The first cohort of participants will start on October 1, 2018, with a performance period running through December 31, 2023. CMS will provide a second application opportunity in January 2020.¹

As hospital systems consider BPCI-A, the post-acute care disposition trends may continue with cardiopulmonary (CP) patients transitioning directly to a home setting versus a post-acute care facility upon hospital discharge. This care redesign trend will provide the cardiac and pulmonary (CR/PR) programs an opportunity to consider innovative approaches (see R2R TurnKey strategies) to start their CP patients earlier in outpatient programs or collaborate with home care agencies to transition patients to CP programs at the completion of their home care episode. Your CPR programs should be engaged with cardiovascular or pulmonary service lines, if your hospital is considering participating in this BPCI-A. Cardiopulmonary rehabilitation adds value-based care to patients receiving this service, such as a reduction in readmissions², if patients are referred, enrolled and adhere to CPR programs.

The AACVPR Healthcare Reform Committee is looking to identify CPR programs that are involved in APMs and delivering best practice innovated models. If you are involved in an innovative program, please reach out to send us feedback on the success of these programs.

1. www.acc.org/latest-in-cardiology/article/2018/02/13/14/42/heart-of health-policy-cms-announces-new-voluntary-bundled-payment-model
2. Dunlay SM, Pack QR, Thomas RJ, Killian JM Participation in Cardiac Rehabilitation, Readmissions, and Death After Acute Myocardial Infarction. The American Journal of Medicine (2014) 127, 538-546