CMS' decision to ax mandatory bundled payments a step back for value-based care, doctors say

Voluntary bundled payments are likely less effective than the mandatory version, according to a trio of physicians. (Pixabay)

CMS' decision to cancel two mandatory bundled payment programs is a step in the wrong direction for value-based care, a group of physicians argue. 

The Centers for Medicare & Medicaid Services ended mandatory bundled payments for cardiac and hip replacements in a rule issued at the end of November and reduced the number of geographic regions participating in the mandatory joint replacement model. CMS delayed the program several times after the Trump administration took office, but the model was supposed to take effect on Jan. 1. 

The decision will allow hospitals greater flexibility in how they care for patients, according to CMS. But in a piece for the Journal of the American Medical Association, three physicians argue that a fully voluntary bundled payment model will only include a small fraction of providers and offer them a chance to leave early.


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The voluntary bundled payment programs created by CMS under the Obama administration did not attract a large number of hospitals to participate, just 10%, wrote Rishi Wadhera, M.D., and Robert Yeh, M.D., medical professors at Harvard, and Karen Joynt Maddox, M.D., assistant professor of medicine at Washington University School of Medicine. And half of those hospitals left the program early, the trio wrote, which limits the effectiveness of the model and how much data was gathered on what worked in the program. 

RELATED: 3 key elements for the next generation of bundled payments 

The physicians added that though some providers initially resisted the mandatory bundles, early reports indicated that the mandatory bundles increased collaboration between hospitals, physicians and post-acute care and led to cost reductions.  

"The mandatory cardiac bundled payment program could have built on this momentum, and its cancellation represents a lost opportunity to improve the delivery and efficiency of care," they wrote. 

RELATED: Industry experts cautiously optimistic about Trump administration's approach to value-based care 

Though the Trump administration did cancel two mandatory bundled payment programs and significantly scale back a third, officials at CMS say they are still committed to the transition from volume to value. 

The agency unveiled a new voluntary bundled payment program last week and has also been considering a new payment model aimed at rising drug prices. 

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