179 members of Congress have accused CMS of overstepping its authority in making bundled payment models, like one for cardiac episodes, mandatory without getting their approval.

The Sept. 30 letter to CMS Acting Administrator Andy Slavitt and CMO Patrick Conway, MD, was signed by 178 Republicans and one Democrat, Rep. Brad Ashford of Nebraska.

The letter said CMS’s Center for Medicare and Medicaid Innovation (CMMI) overreached by making new bundled payment models mandatory, arguing the center was only charged with testing new payment and service delivery methods on a limited, voluntary basis. Going beyond those parameters, the lawmakers said, would reduce the quality of care for elderly patients.

“Policies that have the potential to create access issues for beneficiaries, further provider consolidation, and reduce provider participation in Medicare can drastically deteriorate quality of care our seniors rely on,” they wrote. “This would be a step backwards in our unified effort to move to higher quality, more value-based care for our nation's seniors. We ask that you cease all current and future planned mandatory initiatives under the CMMI.”

The letter attacked three models specifically: the Comprehensive Care Joint Replacement (CJR) model finalized in Nov. 2015, the cardiac bundled payments proposed in July 2015 and the Medicare Part B drug payment model proposed in March. The letter said these models have been developed without input from stakeholders, don’t include safeguards to protect quality and access to care, and should be implemented on a much smaller scale.

“As a result, Medicare providers and their patients are blindly being force into high-risk government-dictated reforms with unknown impacts," the congressmen wrote. "Any true medical experiment requires patient consent. However, patients residing in an affected geographical area will have no choice about their participation."

Industry groups have raised similar concerns, with the cardiac model in particular garnering mixed reactions. The American College of Cardiology supported the broad goals but also suggested they may need to be altered, while Health Care Incentives Improvement Institute suggested an alternative episode-based payment methodology.

There have also been mixed results on studies assessing the effects of bundled payments. A CMS analysis of smaller, voluntary joint replacement and cardiac episodes models found inconsistent savings while quality scores often didn’t decline. An analysis by Avalere Health of the new cardiac model predicted it wouldn’t affect the bottom line at most hospitals.