Providers oppose fed's plan to bundle payments for joint replacements

Providers are pushing back against a proposal by the Centers for Medicare & Medicaid Services (CMS) to bundle payments for joint replacements.

The American Health Care Association (AHCA), the primary trade organization for skilled nursing facilities, said it considered the proposal premature, according to McKnight's.

"While AHCA supports the concept of bundled payments generally, we believe it is too early for CMS to propose a mandatory model and too premature to design a model with the hospital as the bundle owner," the organization said in a letter to CMS, according to the article. 

CMS announced the five-year initiative in July, with the intent of lowering the cost and increasing the quality of such procedures. Hospitals would be placed at risk for some of the payment depending on the patient outcomes. Altogether, CMS pays about $7 billion a year for the replacement surgeries, and the rates of infections and complications can be three times higher at some hospitals compared to others.

Meanwhile, the American Hospital Association (AHA) has told the CMS in a letter that it supports bundled payments for joint replacement. But at the same time, it has asked that the agency waive Stark Law self-referral rules in lieu of a safe harbor.

"At its core, the self-referral law is about separating hospitals and referring physicians, while the evolving Medicare and Medicaid models are premised on the close integration of a variety of different healthcare providers. The Anti-kickback Statute is similarly no longer compatible with the new models," said the letter to acting CMS Administrator Andrew Slavitt from AHA Executive Vice President Thomas P. Nickels.

The AHA also has asked for a delay in the implementation of the rule for six months, from Jan. 1 of next year to July 1, and to restrict the program to elective joint replacements only.

To learn more:
- read the McKnight's article 
- check out the AHA letter (.pdf)