In its latest move away from Obama era Medicare initiatives, the CMS finalized canceling the mandatory hip fracture and cardiac bundled payment models in the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model.
The Episode Payment Model and the Cardiac Rehabilitation Incentive Payment Model were scheduled to begin in January.
Meanwhile, the CMS said it’s reducing the number of mandatory geographic areas in the CJR from 67 to 34. The CMS is also making participation voluntary in those areas for low volume and rural hospitals.
The news isn't exactly a surprise. The CMS already announced the possible changes in an earlier proposed rule. The CMS said the new rules give the agency more flexibility to design and test programs to improve quality and care coordination while reducing costs. They also offer hospitals greater flexibility and the ability to choose what’s best for them rather than being required to participate in bundled payment programs.
CMS Administrator Seema Verma said the CMS still supports voluntary bundled payments and will soon announce new voluntary valued-based programs. She said the CMS wants to develop bundled payment models with more provider involvement. Verma said that’s the best way to drive change in healthcare while “minimizing burden” for providers.
CMS’ announcement on Thursday also included an interim final rule with comment period. During the period, the CMS will seek comments on a “final policy to provide flexibility in determining episode costs for participant hospitals located in areas impacted by extreme and uncontrollable circumstances, such as the major hurricanes of 2017,” according to the CMS.
CMS’ announcement is part of an ongoing trend to move away from mandatory bundled payments at the agency this year. Instead, CMS leadership prefers voluntary initiatives, which was also former HHS Secretary Tom Price’s stance. Despite CMS’ push for voluntary programs, some healthcare experts say mandatory payment programs are needed to improve patient care. The topic divides provider groups.
Some providers back voluntary programs because it allows hospitals to choose which programs make sense for their facilities. When the CMS announced the proposed rule over the summer, the American Hospital Association (AHA) said it supports bundled payment programs and was concerned about canceling the programs.
“We are concerned that a mandatory cancellation of the cardiac and (surgical hip and femur fracture treatment) programs may be disruptive to providers who have expended valuable resources to put these programs in place," said Ashley Thompson, AHA senior vice president for public policy analysis and development, at the time.
However, on Thursday, the AHA said it generally supports CMS' changes and looks forward to new voluntary programs. “We are pleased that CMS has signaled that it will soon announce new voluntary payment bundles that will qualify as advanced alternative payment models. Doing so will allow hospitals to not only capitalize on the work many of them already have done to prepare for such models, but also partner with clinicians to provide better, more efficient care," said AHA Executive Vice President Tom Nickels.
The Brookings Institution also recently said the programs should be mandatory. Voluntary models are not likely to generate enough data to determine effectiveness. Also, selective participation can affect results. Brookings added that CMS’ move away from bundled payments could affect private payment reforms that complement CMS programs.
Meanwhile, Verma continues to look to revamp many pieces of CMS. In addition to reworking or cutting value-based programs, the CMS also seeks to reduce regulatory burdens, provide more flexibility for state Medicaid programs and decide how best to measure quality without adding work onto providers. The CMS also recently received guidance from healthcare stakeholders about possible changes to its Center for Medicare and Medicaid Innovation.
“Our vision is to develop models that promote a patient-centered system of care within a market-driven healthcare system. Models should empower consumers to make decisions that are right for them and providers should compete around value and quality,” she said recently.
We @CMSGov believe the best way to drive health system change while ⬇ burden & maintaining access to care is through developing different bundled payment models & engaging more providers. https://t.co/opTM41QYoZ— CMS Administrator (@SeemaCMS) November 30, 2017