Medicare Bundled Payment

As of January 1, 2020, John Muir Health has been selected as a Bundle Payment Care Improvement (BPCI) Advanced Model Year 3 Participant for Medicare Beneficiaries.

What is BPCI Advanced?

BPCI Advanced is a voluntary bundled payment program that incentivizes hospitals and physicians to work together to improve quality and costs. The hospital takes responsibility for coordinating the care and has financial risk for the quality and cost of care. So this means, that if John Muir Health does not deliver the standard of care that Medicare targets, we will not receive additional payment for your services

What are bundled payments?

A bundled payment combines, or bundles together, payments that Medicare makes to all of your health care providers for the many different kinds of medical services you might get in a specific time period. In BPCI Advanced, the bundle is activated during your hospital stay, and will include the hospitalization, and all Medicare services provided during the 90 days following discharge. This doesn’t change your Medicare rights or benefits and you don’t need to do anything. Upon discharge, you will receive a Beneficiary Notification letter with further details if you have any questions.

Which Patients are part of BPCI Advanced?

BPCI Advanced applies to traditional Medicare patients only (must be entitled to CMS Part A and enrolled in CMS Part B), whose admission or procedure places them in one of the selected bundles (see selected bundles below).

CMS excludes patients that are include Mine Workers, Medicare Advantage or Healthcare Prepayment, end-stage renal (ESRD), Medicare Secondary or other beneficiaries.

Why would Medicare bundle payments?

Bundled payments are a “value-based” initiative that holds health care providers responsible for both the quality and cost of medical care they give. Bundled payments encourage your physicians, hospitals and all providers to work together to provide better, more coordinated care during your hospital stay, post-acute care, and throughout your recovery.

Why is John Muir Health participating?

John Muir Health maintains its commitment to being innovative with a focus on quality and costs, by participating in alternative payment models such as bundled payments. Participating in this model will lead to streamlined, coordinated care episodes that improve quality and the patient experience and reduce costs (defined as what Medicare pays for services).

John Muir Health has demonstrated success in similar models in the past through the Comprehensive Care for Joint Replacement (CJR) model and seeks to continue this success within BPCI Advanced.

What does BPCI Advanced mean for me?

Better coordination of care occurs when hospitals, doctors, and other health care providers work together. By working together, the health care providers within BPCI Advanced are trying to more efficiently provide well-managed, high quality, patient-centered care as you undergo treatment. Medicare will monitor your care to make sure you and others get high quality care within BPCI Advanced.

Which John Muir Health procedures have been selected?

• Cardiac Procedures
  • Cardiac Defibrillator (IP)
  • Cardiac Defibrillator (OP)
  • Cardiac Valve (IP)
  • CABG (IP)
  • PCI (OP)
  • PCI (IP)
  • Pacemaker (IP)
• Medical & Critical Care
  • Cellulitis (IP)
  • COPD, Bronchitis, Asthma (IP)
  • Renal Failure (IP)
  • Sepsis (IP)
  • Simple Pneumonia and Respiratory Infections (IP)
  • UTI (IP)
• Neurological Care
  • Seizures (IP)
  • Stroke (IP)  

Which Skilled Nursing Facilities have partnered with John Muir Health?

As we coordinate your care at discharge within BPCI Advanced, we have partnered with the following Skilled Nursing Facilities that meet the high standards of patient care for John Muir Health and CMS. Your care team will provide further information regarding our Preferred Skilled Nursing Facilities as well as all other Skilled Nursing Facilities if this type of care is recommended for you.

Where can I learn more about BPCI Advanced?

For more information, you can:

• Visit the CMS BPCI Advanced Website at https://innovation.cms.gov/initiatives/bpci-advanced/
• Call 1-800-Medicare (1-800-633-4227). TTY users can call 1-877-486-2048.