- The CMS on Tuesday published a proposed rule to cancel the cardiac bundled payment program and the episode payment models program, which were set to begin in January.
- The agency also proposed reducing the mandatory geographic areas for the joint bundled program from 67 to 34. Providers in the areas no longer required to participate would be able to do so voluntarily.
- The CMS predicts between 450 and 470 hospitals would participate in the joint bundled program, including 60 to 80 on a voluntary basis.
Bundled payment programs have been shown to reduce costs without the quality of care suffering and are a relatively popular payment model among those leading the push to value-based payment. The data on their success are mixed, but leans toward positive results.
The episode payment models program included the Acute Myocardial Infarction model and the Surgical Hip and Femur Fracture Treatment (SHFFT) model. Between them, they were expected to have about 2,000 participants.
The American Hospital Association (AHA) said it supports bundled payment programs as a way to help transform care delivery. “We are concerned that a mandatory cancellation of the cardiac and SHFFT 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.
In reaction to the cancellation of the cardiac bundled payment program, American College of Cardiology President Dr. Mary Norine Walsh stated, “The [ACC] will continue to work with CMS on opportunities for clinicians to participate meaningfully in Advanced Alternative Payment Models. As we move from volume-based care to value-based care, the path forward is challenging and we must work together to find solutions.”
Hospitals have disagreed with each other as to whether bundled payment programs should be mandatory, but most argue for voluntary participation because some hospitals can struggle with the flexibility needed to adopt new payment models.
Policy analysts at the Brookings Institution, however, say the programs should be mandatory for a number of reasons. Voluntary models aren’t likely to generate enough data to determine effectiveness, and selective participation can skew results. Voluntary participation would be far less likely to accurately reflect the models’ success, because they would probably not include safety net hospitals and those slow to adopt to value-based models in general, the organization said.
Brookings said backing away from the bundled payment programs would curtail the potential effectiveness of the Center for Medicare and Medicaid Innovation, which developed them. “In addition, such a retrenchment could have ripple effects for private payment reform efforts that attempt to complement CMS programs,” they said.
The move to cancel and scale back bundled payment programs is no surprise under HHS Secretary Tom Price, who has been a vocal opponent of the models and in particular their requirement for providers to participate.
In a statement, however, the CMS indicated at least some payment reform models will continue to be pursued.
"Stakeholders have asked for more input on the design of these models," it said. "These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries."