Hospitals raise concerns about cardiac bundled payments


Hospitals generally embrace the Medicare program's proposed bundled payment programs for cardiac care, but they have cautioned the federal government to consider restraining how quickly it deploys the initiative. The sector has also raised concerns about the expansion of bundled payments for certain joint replacement procedures.

The American Hospital Association has warned (.pdf) the Centers for Medicare & Medicaid Services that the agency must slow its pace. It noted that knowledge from the deployment of the joint replacement program to apply to the cardiac program remains scant at this point.

CMS introduced the bundled joint replacement program late last year. It is intended to save the Medicare program as much as $343 million over its first five years of deployment. However, some industry experts have raised concerns that the program won't do enough to keep surgical volumes in check.

The AHA is concerned  that there are more than 75 target prices for cardiac diagnoses and procedures, suggesting that they are too complex for hospitals to track and verify if they can perform them and not lose money.

“This proposed rule raises serious concerns about the agency’s pace of change, as well as its ability to accurately track and process the outcomes of its myriad increasingly complex alternative payment models,” said the letter from AHA Executive Vice President Thomas Nickels to acting CMS Administrator Andrew Slavitt. “As such, we urge CMS, in the strongest possible terms, to refrain from expanding mandatory bundled payment models to other geographic areas or conditions before there has been enough time to assess the lessons learned under the existing models.”

The AHA also objects to the agency's plans to expand joint replacement bundles to include surgical hip and femur fracture episodes, or pressing hospitals already participating in the joint replacement to also implement the bundled cardiac payment model. It asked for at least a 15-month window for the deployment of the former prior to accepting risk.

“Hospitals do not have an unlimited capacity to implement bundled payment models,” Nickel's letter said.