CMS holds off on bundled payment expansion, implementation

A new interim rule released Monday delays the expansion and implementation of major bundled payment initiatives and calls into question whether the new White House administration is committed to the programs.

In the interim rule (PDF), posted to Monday’s Federal Register, the Centers for Medicare & Medicaid Services:

  • Delays the implementation of the mandatory cardiac bundle program and cardiac rehabilitation program from July 1 to Oct. 1.
  • Postpones the expansion of the mandatory joint replacement bundle program to include other treatments for hip and femur fractures in addition to hip replacement from July 1 to Oct 1.
  • Further delays the effective date of a final rule to implement the joint replacement bundle initiative, the cardiac rehabilitation incentive payment model and the initiative to advance care coordination through episode payment models from March 21 to May 20.
  • Seeks comment on a potential further delay of the programs to Jan. 1, 2018.

These programs were part of a final rule issued in December, but CMS says the additional three-month delay allows the agency more time to review comments and modify the policy if necessary.

The December rule held acute care hospitals accountable for the quality and cost of care Medicare patients receive during  inpatient stays and 90 days after discharge for treatment of a heart attack, bypass surgery or a hip or femur procedure.

The cardiac models apply to hospitals located in 98 metro areas. The surgical hip fracture treatment model applies to hospitals in 67 metro areas, which are the same metro areas currently included in the Comprehensive Care for Joint Replacement Model.

The latest delay came as welcome news to the Federation of American Hospitals and the American Hospital Association, which expressed concern last year that the accelerated pace of the program.

But the postponement also calls into question the future of the program. Newly appointed Health and Human Services Secretary Tom Price is not a fan of mandatory bundled payment initiatives. The former congressman has opposed mandates for bundled payments and last year wrote a letter to CMS, claiming the agency overstepped its bounds by requiring bundled payments because they took the decision away from patients and physicians.

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