CMS to cancel mandatory bundles

A rule title posted to the Federal Register on Aug. 10 indicates CMS will cancel two mandatory bundled payment programs, the Advancing Care Coordination through Episode Payment Models (EPMs) and Cardiac Rehabilitation Incentive (CRI) Payment Models, while changing a separate payment program on joint replacements.

The pending regulation offers no specifics about the policy, but these same bundles have already been delayed twice since HHS Secretary Tom Price, MD, and CMS Administrator Seema Verma, MPH, took the reins at the agencies. Both have been critical of making bundled payments mandatory, with Price—himself an orthopedic surgeon—having proposed legislation as a congressman to delay the orthopedic bundle. Verma had said in her own confirmation hearing that new payment models should be expanded more gradually.

“We need to make sure we’re not forcing, not mandating individuals to participate in an experiment, a trial that there’s not consent around,” she said.

Opinion within the industry has been mixed. Several groups, like the Federation of American Hospitals, have argued CMS doesn’t have the authority to force providers to participate in any payment model, and called on Verma and Price to make these upcoming bundles voluntary. Other stakeholders, like Pennsylvania’s Geisinger Health System, have supported delaying the bundles until 2018, but making them voluntary would limit the value of its results.

“The ability of CMS to evaluate this program rigorously is dependent on having a broad cross-section of participants,” the health system said in its April comment. “In contrast, the early evaluations of Bundled Payment for Care Improvement were limited due to the relatively small sample of participants in most clinical episodes. Participants in voluntary models tend to be early adopters whose performance may be systematically different than hospitals that choose not to participate – limiting the generalizability of program results.”

The cancellation of the bundles would eliminate an avenue for practices to earn the 5 percent bonus in the Advanced Alternative Payment Models (AAPMs) track introduced through the Medicare Access and CHIP Reauthorization Act (MACRA).

HHS and CMS didn’t respond to a request from HealthExec for clarification on the scope of the changes to the payment models.