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HHS Proposes Eliminating or Changing Mandatory Bundled Payment Programs

August 14, 2017
by Heather Landi
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The Department of Health and Human Services (HHS) has proposed eliminating mandatory bundled payment in several areas of healthcare including cardiac care and joint replacement, according to a rule title posted last Thursday.

There are few details known about the proposed rule as the only information publicly available is the title, “Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model.”

The proposed rule could signal that HHS is looking to overhaul its approach to the Medicare bundled payment programs.

HHS Secretary Tom Price, M.D., has voiced skepticism about mandatory bundled payment programs. As previously reported by Healthcare Informatics, last fall, when Price still served as a Congressman from Georgia, he was one of 200 federal lawmakers who sent a letter to Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), calling out the Center for Medicare and Medicaid Innovation (CMMI) for overstepping its authority by proposing mandatory healthcare payment and service delivery models.

Congressman Price, Charles Boustany, M.D., and Erik Paulsen wrote a letter to CMS, which was signed by 179 members of Congress, stating that three recently proposed mandatory models demonstrate that CMMI has “exceeded its authority, failed to engage stakeholders and has upset the balance of power between the legislative and executive branches.”

In the letter, the legislators state that the proposals would negatively impact patients. "We ask that your cease all current and future planned mandatory initiatives under the CMMI,” the legislators wrote.

What’s more, during her first Senate confirmation hearing back in February, Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), also gave similar thoughts to Sec. Price when it comes to mandatory bundled payment models. During that hearing, as reported by Healthcare Informatics, she said that she “support efforts around innovation, as it’s important that we are trying to climb the highest mountain. Innovation is important, as we look at testing new ideas. That process has to be sure of a couple of things, like making sure we are not mandating people to participating in something there is not consent around.”

The September letter from the 200 federal lawmakers specifically cites the CMS final rule requiring at least 800 hospitals in 67 geographical areas selected by CMS to participate in a new bundled payment model for hip and knee replacements, the Comprehensive Care Joint Replacement (CJR) Model, as well as a proposed rule requiring thousands of providers to comply with a new drug payment model under Part B of Medicare (the Part B Drug Payment Model). In addition, the legislators also cite the cardiac bundled payment model CMS announced in July that requires some providers to participate in bundled payments for certain cardiac conditions as well as expansion of the CJR model.

The legislators state that the CMMI models were developed without input from impacted stakeholders and fail to include safeguards to protect the “delicate balance of quality, cost and access to care for beneficiaries.”

 

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