On July 18, the Centers for Medicare & Medicaid Services (CMS) released a request for information (RFI) to aid the design of a future episode-based payment model. The announcement does not specify any specific conditions that the potential episode-based payment model would target.
The potential model would encourage participants to take responsibility for a patient’s full range of care needs during a clinical episode, rather than incentivizing individual services. Through this RFI, CMS seeks stakeholder input on:
- Care delivery and payment alignment.
- Appropriate clinical episodes.
- Potential participants.
- Health equity considerations.
- Quality measures and multipayer alignment opportunities.
- Payment methodology and structure.
The future episode-based payment model would be designed with the goal of improving beneficiary care and lowering federal health care expenditures by reducing fragmentation and coordinating care across health care settings.
The model would build on previous models, such as Bundled Payments for Care Improvement (BPCI) and BPCI Advanced. CMS plans to implement the model no earlier than 2026.
Comments are due Aug. 17.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.
