- The Centers for Medicare and Medicaid Services plans to require hospitals in 75 different areas to test out bundled payments for hip and knee surgeries. The proposed rule is an attempt at pushing certain kinds of hospitals that haven't signed up for the voluntary bundling program to participate.
- The new requirement will involve more than 800 hospitals with a variety of utilization patterns, local market profiles and access to capital, according to the agency. Markets will vary in size from New York and Los Angeles to smaller ones like Flint, MI.
- The program would begin Jan. 1, 2016 and run for five years. Hospitals would continue to be paid FFS and at the end of the year would receive additional payments or be required to repay Medicare for a portion of episode costs, depending on performance. Hospitals would not assume risk until year two.
This proposal sends a pretty strong message that the administration is not going to tolerate foot-dragging when it comes to the shift to value-based reimbursement. "This is the first really strong signal that this is where the industry is going," Avalere's Brian Fuller said.
Still, some stakeholders think it's "too much, too fast." Hospitals that haven't invested in IT infrastructure and care coordination models may find themselves unable to meet the quality requirements of the program.
"A voluntary, national program would ensure that only providers who are ready to take on this challenge enter the program, avoiding unintended consequences," Premier Senior Vice President Blair Childs said.
Comments on the proposed rule are due September 8.