CMS cancels mandatory hip fracture and cardiac bundled payment models

Frank
March 13, 2019
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The Centers for Medicare and Medicaid Services has finalized the cancellation of the mandatory hip fracture and cardiac bundled payment programs, which were scheduled to begin on January 1, 2018.

The agency has also made changes to the Comprehensive Care for Joint Replacement Model, or CJR. As part of the final rule, CMS cut down the number of mandatory geographic areas participating in CJR from 67 to 34. And participation will be voluntary for low-volume and rural hospitals in all 67 regions.

In a statement, CMS Administrator Seema Verma said the agency believes “that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care.” She added that CMS expects to announce new voluntary payment bundles in the future.

The news is hardly surprising, given that in August, the Department of Health and Human Services issued a proposed rule eliminating the mandatory bundled payment programs. HHS had already delayed the bundles twice this year — once in March and again in May.

On top of that, Verma is hardly a huge fan of bundled payments. In her confirmation hearing before the Senate Finance Committee earlier this year, she said she doesn’t believe such models should be mandatory.

“We need to make sure we’re not forcing, not mandating individuals to participate in an experiment, a trial that there’s not consent around,” she said, according to Health Exec.

In a recent phone interview, naviHealth COO Carter Paine said the cancellation is far from a shocker.

“It’s a mere formality at this point,” he said. “Everyone knew it was coming. This administration, even with Tom Price out, clearly has a view that voluntary is a better route to go and [a way to] get more of the provider community behind the value-based care movement.”

In an emailed statement, DataGen Director of Informatics Darcie Hurteau pointed to the future implications of stopping mandatory bundles, noting it “will give organizations who are not as prepared an opportunity to learn some best practices from those who are more advanced, and organizations that are more advanced will have an opportunity to further their goals.”

She also commented on CMS’ changes to the CJR program. Participants will have to look at the ROI they’re seeing, how their physicians are responding and how the program is performing from a financial perspective before they decide whether to stay in the program, Hurteau said.

Photo: Oko_SwanOmurphy, Getty Images

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Frank’s source: https://medcitynews.com/2017/12/cms-bundled-payment-models/

 

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