The Centers for Medicare & Medicaid Services this week proposed rolling back a trio of bundled payment pilot programs aimed at lowering healthcare costs and improving outcomes.
The federal health insurer announced its 5-year “Comprehensive Care for Joint Replacement” program in July 2015, saying it would involve more than 800 hospitals in 75 geographic areas. The CJR program, which went into effect in January 2016, bundles payments for hip and knee replacements from hospital admission to 90 days after discharge. The payment covers “all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries,” CMS said at the time. Reimbursement is also pegged to outcomes and cost, giving Medicare the ability to claw back payments or reward good performance with addition payments; the CJR program aims to save about $150 million over 5 years.
Another program, the Cardiac Rehabilitation Incentive Payment Model, is designed to pay hospitals a fixed price for each “care episode” for patients treated for heart attack or bypass surgery, with higher prices paid to hospitals that deliver higher-quality care. The program also includes incentives designed to push hospitals to better manage cardiac rehabilitation services in the 90 days after discharge, with the aim of improving patient adherence to rehab plans. A third, the Episode Payment Model, bundled reimbursement for acute myocardial infarction and coronary artery bypass graft.
In an August 15 press release, CMS proposed scaling back the number of mandatory-participation geographies in the joint replacement program from 67 to 34 and make participation voluntary in the remaining areas and for low-volume and rural providers in all areas. The cardiovascular programs, which were slated to launch in January 2018, would be canceled, according to the agency’s proposal.
“Eliminating these models would give CMS greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute-care spectrum,” CMS said in the release.
“Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” added administrator Seema Verma. “Stakeholders have asked for more input on the design of these models. 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.”