March 21, 2019 / Robert King and Maria Castellucci
The number of healthcare providers participating in the CMS’ advanced bundled payment model has declined by 16% since the program started five months ago, as providers choose to get out now to avoid financial risk.
The CMS announced Thursday that 1,086 healthcare providers are participating in the Bundled Payments for Care Improvement Advanced model, the first alternative payment model unveiled during the Trump administration. The model was initially rolled out by the CMS in October with 1,299 participants. 
The BPCI Advanced model—which runs through Dec. 31, 2023—is a single retrospective bundled payment model that combines payments to the physician, hospital and other healthcare provider services. Participants can get an additional payment if all the costs for an episode of care are less than a benchmark price, discounted by 3%. If they exceed the benchmark, the providers would have to repay up to 20% of the excessive costs to Medicare.
The BPCI Advanced model gives participants preliminary target benchmark prices before the start of the model year to help them plan.
When the model was rolled out in October, there were 832 acute care hospitals and 715 physician group practices participating, representing a total 1,547 Medicare providers. However, that number has declined to 715 hospitals and 580 physician group practices for a total of 1,295 providers, according to CMS data.
The rollout of the model was bumpy, as the CMS was late in giving out claims data to providers, which they needed to decide which bundles to select. Providers had to determine whether to stay in the model by March 1.
The CMS announced the withdrawal option in early July, before BPCI participants officially had to sign agreements for the program in August. This raised the possibility that some would sign up for the program even if they were unprepared because they knew the withdrawal option was available to them, said Gina Bruno, vice president for clinical strategy at naviHealth, a convener for hospitals that participate in BPCI.