​​​​​​​CMS planning to ax cardiac bundled payments, scale back joint replacement bundles

cms
CMS has proposed canceling the cardiac bundled payments program, which is set to begin Jan. 1.

The Centers for Medicare & Medicaid Services wants to scale back the number of geographic regions participating in the mandatory joint replacement bundled payment program and fully cancel cardiac bundled payments.

In a rule (PDF) posted yesterday in the Federal Register, CMS proposed reducing the number of regions participating in the mandatory Comprehensive Care for Joint Replacement program from 67 to 34, while allowing the remaining 33 regions to participate voluntarily.

Canceling the cardiac bundled payments allows CMS greater flexibility in designing and piloting new payment models, it said in an announcement. The program is set to begin on Jan. 1, 2018.

Product Spotlight

Top-Rated Mobile App for Health Insurance Members

Zipari’s Mobile App is the smarter, easier, and better way for payers to engage members on the go and directly in the palm of their hands. Members can find the right doctors, receive notifications, send messages, view claims, track spending, talk to a nurse, download ID card, and more. It’s ready to install and launch in a few months.

The Department of Health and Human Services last week signaled the government was planning changes to the program, as FierceHealthcare reported, though the new rule contains more detail.

RELATED: HHS makes move to put an end to mandatory bundled payment models

Bundled payment models pay a group of providers a lump sum for an episode of care. The Center for Medicare & Medicaid Innovation experimented with the model, with hospitals participating voluntarily, but under the Obama administration there was a call to make the model mandatory to further the push for value-based care.

HHS Secretary Tom Price has been an outspoken critic of the move, saying CMS overstepped its bounds in making the programs mandatory, as that took away choices from patients and physicians. CMS has delayed the implementation and expansion of bundled payments multiple times during his tenure.

RELATED: CMS further delays bundled payment implementation, expansion to January

CMS Administrator Seema Verma said in the announcement that the changes allow other stakeholders to provide more input on alternative payment models and that allowing greater flexibility will lead to better patient care.

“Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs and ease burdens on hospitals,” she said.

The agency said that it intends to develop more voluntary alternative payment programs moving forward.

Suggested Articles

DOJ filed suit against Cigna on Tuesday, alleging that the insurer used a primary care program launched in MA to boost its risk scores.

Missouri became the latest state to OK a Medicaid expansion through a ballot measure, winning the approval of 53.2% of voters.

Telehealth giant Teladoc is acquiring virtual care company Livongo in a deal valued at $18.5 billion.