CMS further delays bundled payment implementation, expansion to January

CMS will further delay its new bundled payment programs, according to a new final rule.

The Centers for Medicare and Medicaid Services has delayed the expansion of its existing bundled payment programs and the start of new ones until January 2018, raising further questions about the Trump administration’s commitment to the programs.

CMS posted an interim final rule in March that delayed the start of its new payment bundles and changes to the existing Comprehensive Care for Joint Replacement (CJR) program from July 1 to October 1. But in a final rule (PDF) posted in the Federal Register late last week, the agency further delayed the initiative. The delay was not an unexpected move, as the interim rule hinted that the administration may modify or eliminate the bundled programs in the future.

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The CJR demonstration began in April 2016, and CMS intended to extend bundled payments to cardiac care and to push for better care coordination.

Comments on the interim rule said that more time was needed to prepare for the payment bundles, leading to the additional delay, a CMS spokesperson told Medscape Medical News.

Department of Health and Human Services Secretary Tom Price is less than enthusiastic about bundled payment models, as FierceHealthcare has previously reported, another sign that the future of these programs is murky. Last year, while serving in the House of Representatives, Price sent a letter to the CMS saying that the programs overstep the agency’s bounds.

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However, research suggests that providers do see cost reductions using bundled payments. Baptist Health System in San Antonio, Texas, for instance, saw the costs of implants and post-acute care for joint replacement patients drop by 29% and 27%, respectively, between 2008 and 2015 under the CJR program.

Studies have also linked bundled payments and other value-based care programs to reduced readmission rates.

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