CMS Proposed Rule Could Scale Back Mandatory Bundled Payment Programs

Sep 1, 2017 | Uncategorized

CMS Proposed Rule Could Scale Back Mandatory Bundled Payment ProgramsCMS released a proposed rule earlier this month that could cancel two bundled payment programs, and significantly limit a third.nnTwo bundled payment programs could be canceled before they begin, and the scope of a third will be significantly limited if a proposed rule released by CMS August 17 is finalized.nnThe agency proposes cancellation of Episode Payment Models (EPM) and the Cardiac Rehabilitation (CR) incentive payment model in the rule. In addition, CMS proposes to make participation in the Comprehensive Care for Joint Replacement model (CJR) voluntary in 33 of the 67 geographic areas where participation is currently mandatory. The agency also suggests making participation in the CJR voluntary for low-volume and rural hospitals in all areas.nnThe EPM and CR models were mandatory programs for certain providers that were originally scheduled to begin months ago, but multiple delays pushed that start date back to January 1, 2018. The models were created to institute bundled payments for episodes of care for treatment of acute myocardial infarctions, coronary artery bypass grafts, surgical hip and femur fractures, and cardiac rehabilitation by linking payment to quality outcomes.nnParticipation in the CJR model began in April 2016, and therefore CMS will not cancel that program but proposes to substantially reduce the number of providers who must participate.nnWhile cutting these programs may seem like a shift away from value-based care, CMS said in a press release that it hopes canceling these programs would allow stakeholders to devote time and resources toward creating other episode-based models.n


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