BPCI Advanced FAQs


Should I apply by March 12?

Yes; applying to participate in BPCI Advanced is non-binding and you won’t have another chance until January 2020. Most hospitals have significant opportunity to save in at least one bundle. If your application is successful, you still won’t have to commit to anything until August 2018. Plus, should you choose to partner with Avant-garde Health, we can make the process even easier by taking care of the application for you.

What are my options for participating in BPCI Advanced?

There are two ways to participate in BPCI Advanced: (1) independently, as a Non-Convener Participant, and (2) with a Convener. As a Non-Convener Participant you bear the financial risk, without any downstream entities, as well as the administrative burden. When you apply with a Convener like Avant-garde Health, you have the opportunity to off-load the administrative responsibility - and potentially also some of the financial risk - onto us. If you’re not sure which option you’d prefer, you can always submit two applications - one as a Non-Convener Participant and the other with a Convener - and choose your status later. We can help with both.

Should I apply as a Non-Convener Participant or with a Convener?
Both! It is possible to submit both applications before the March 12th deadline, and if both are successful you won’t have to make a final decision until August 2018. As your partner in navigating BPCI Advanced, Avant-garde Health can take care of both applications for you.

How do I know which BPCI Advanced Clinical Episodes (i.e. bundles) to choose?

The best BPCI Advanced bundles for you will be those where you have (1) sufficient volume and (2) opportunity to reduce post-acute care spend relative to the Target Price set by CMS. Avant-garde Health offers a complimentary evaluation of your opportunity across the different bundles, based on our best estimate of the CMS target price. After you submit an application to BPCI Advanced, CMS will provide a more detailed explanation of Target Price calculations. But keep in mind that your March 12 application is non-binding, and you will not have to finalize your chosen bundles until August 2018.

How is the reconciliation amount determined for BPCI Advanced bundles?

The reconciliation amount will be the difference between CMS’s expected spend (volume x Target Price) and the actual spend for a given DRG. If actual spend is less than expected spend, you will receive a reconciliation check in the amount of the difference. However, reconciliation will be capped at 20% of the Target Price, limiting both the upside benefit and the downside risk to participation.

If our organization is participating in another payment model, can we still participate in BPCI Advanced?

The general rule here is that you can enroll concurrently in BPCI Advanced and other shared savings initiatives, such as the Medicare Shared Savings program. However, CMS prevents BPCI Advanced payments for some ACO beneficiaries, including those aligned to a Next Generation ACO. Hospitals participating in any Innovation Center model implemented via regulation, such as the Comprehensive Care for Joint Replacement (CJR), will not be permitted to participate in BPCI Advanced for the episodes included in those models. Have questions about your eligibility for BPCI Advanced? Avant-garde Health is here to help - reach out to us for a complimentary evaluation of your opportunity.