On April 22, the CMS Innovation Center released the sixth annual evaluation report for the Bundled Payment for Care Improvement – Advanced (BPCI-A) program. Participating providers’ experiences in this voluntary episodic payment model can help inform strategies for hospitals planning to participate in the mandatory Transforming Episodic Payment Model (TEAM) beginning January 1, 2026.
The report includes results for Model Year 5 (2022). BPCI-A is now in Model Year 8, the final year for the program. About one-third of participating providers left BPCI-A between Model Years 4 and 5, as participants continued adjusting to major changes to the program design introduced in Model Year 4. Those who remained performed well: participants reduced expenditures while maintaining quality-related health outcomes, with room for improvement in patient-reported experiences.
Specifically, BPCI-A participants reduced episode expenditures by about $320 million, largely by decreasing institutional post-acute care (PAC) use, especially use of skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). Including the $26.3 million in repayments from participants unable to reduce Medicare expenditures below the target price, BPCI-A generated approximately $344 million in savings to Medicare. Of note, participants were able to reduce PAC use for their selected episodes without increasing hospital readmission and mortality rates.
Through site visits and interviews conducted in Model Year 5, evaluators determined that participants employed multiple strategies to reduce spending in the post-discharge period. First, participants used data furnished by CMS to identify high-cost facilities (i.e., those with longer lengths of stay and higher readmission rates) and to compare their SNF and IRF utilization with peers. This heightened awareness of PAC costs helped shift the culture at participant organizations, leading providers and staff to be more actively engaged in managing patients’ care during the post-discharge period.
Second, participants continued to build relationships with preferred PAC providers to monitor patients and shorten the length of stay in these facilities, many times by having their own physicians, nurses, and pharmacists conduct rounds in these facilities. Third, participants reported that they connected patients with primary care providers after hospitalizations or procedures to ensure successful recoveries and reduce readmissions
Fourth, some participants implemented a formal “Why Not Home” approach to discharge planning to help clinical teams recognize that discharging patients to their homes may be preferable to admitting them to a skilled nursing facility. Key components of this strategy include:
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Helping clinical teams educate patients and their families about why being discharged home is more beneficial than being sent to a post-acute care facility.
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Having case managers identify and help patients secure the resources needed to avoid readmission.
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Connecting patients with physical and occupational therapists who conduct home visits after discharge.
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Adopting functional measurement tools to provide scores that physical and occupational therapy teams use to determine the discharge destination.
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Implementing nurse-driven early mobility protocols to get patients walking while still in the hospital.
Finally, for those patients discharged directly home, participants used care coordinators to monitor patients to identify and address any risk factors for readmissions or emergency room visits.
Other episode cost reduction strategies participants employed included screening patients for medical and social risk factors and either attempting to mitigate these risks or postponing elective surgeries; setting patient and caregiver expectations for recovery through education before and/or during hospitalization; standardizing care pathways and reducing variation in care to decrease unexpected costs; and modifying interdisciplinary rounds to engage multiple providers in each patient’s care and discharge plan.
While the evaluators did not quantify the impact of specific strategies on episode costs, the fact that successful participants employed one or more of them gives TEAM participants reason to evaluate these strategies for their organizations. PYA’s performance transformation team can help your organization build and implement strategies such as those discussed in the BPCI-A evaluation report for TEAM success.
