Decrease in Participation May Lead to Mandatory Bundled Payments

December 16, 2015

A recent Avalere analysis found that participation in the Centers for Medicare & Medicaid Services’ (CMS) voluntary Bundled Payment for Care Improvement (BPCI) dropped, leading researchers to question whether the agency would move to a mandatory bundled payment program.  

Only 25% of providers that expressed interest in the program are currently participating.

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“Strong participation in a voluntary program shows providers’ willingness to test new alternative payment models,” said Josh Seidman, senior vice president, Avalere. “However, the fact that many providers that entered the program decided it’s not currently in their financial interest to accept downside risk may cause CMS to consider additional mandatory programs in the future.”

BPCI is a voluntary program in which hospitals, physician group practices, and post-acute care providers accept clinical and financial risk for patients over specified timeframes. Skilled nursing facilities and hospitals are the most common provider types participating with 46.6% and 27% participating, respectively.

To read the full analysis, visit www.avalere.com/expertise/managed-care/insights/some-providers-leave-governments-bundled-payment-program-those-remaining-ex.Kelsey Moroz