WASHINGTON -- The Centers for Medicare & Medicaid Services (CMS) on Thursday of mandatory bundled payment programs for hip fractures and cardiac care under Medicare, and for an incentive program for cardiac rehabilitation.
"These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients," the agency . CMS administrator Seema Verma noted that "while CMS continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care. We anticipate announcing new voluntary payment bundles soon."
The agency also cut the number of mandatory geographic areas participating in the bundled payment program for joint replacement from 67 areas to 34, and made participation voluntary for all low-volume and rural hospitals "as part of the agency's ongoing commitment to addressing the unique needs of rural providers."
Canceling the hip fracture and cardiac bundled payment models -- which were slated to begin on Jan. 1 -- "gives CMS greater flexibility to design and test innovations that will improve quality and care coordination across the inpatient and post-acute care spectrum," the agency said. "Moving forward, CMS expects to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory bundled payment models. The changes in the final rule will help position the agency to engage in future voluntary efforts."
The American College of Cardiology (ACC) applauded the move. "As clinicians continue the move toward value-based care, the ACC looks forward to working with CMS to create further opportunities for the cardiology community to participate in Advanced Alternative Payment Models," said ACC president Mary Norine Walsh, MD. "While it is disappointing that CMS did not find a way to move forward with the cardiac rehab incentive model, we must work together to ensure these patients are receiving this vital care now and in the future."
In August, when the changes were first proposed, the American Medical Association (AMA) applauded them, noting that the programs had left physicians and post-acute care providers largely on the sidelines.
"Bundled payment models should instead be constructed to give physicians leadership roles in designing the care delivery process and ensuring that it achieves good patient outcomes without unnecessary costs," an AMA statement noted.
The association also cautioned the agency to ensure adequate payments for higher-need patients, "so physicians, hospitals, and others are not placed at financial risk for factors they cannot control."