Some provisions of Medicare’s first mandatory bundled payment model, Comprehensive Care for Joint Replacement (CJR), were recently delayed from February 18 to March 21, but new mandatory models still will launch in July, according to federal officials.
The delay did not affect the CJR expansion model—the Surgical Hip and Femur Fracture Treatment (SHFFT) model—or the Acute Myocardial Infarction (AMI) and the Coronary Artery Bypass Graft (CABG) model. These begin July 1, CMS officials said in a Feb. 22 conference call, according to industry participants. (“Despite Provision Delay, New Bundles on Schedule,” HFMA Weekly, February 24, 2017)
CJR currently has 860 participating hospitals. It launched in April 2016 and places hospitals at risk for all Medicare spending associated with hip and knee replacements and any charges within 90 days of discharge.
The delay in implementing the updated provisions of CJR stemmed from a January memorandum/executive order from the new administration that required 60-day postponements for further review of any published rule that had not yet taken effect.
Hospital executives and industry observers are closely watching CMS for any signs of delays in the coming mandatory models, with the SHFFT model scheduled to launch at existing CJR hospitals and the other two models slated for 1,120 other hospitals, including some CJR hospitals. (“Despite Provision Delay, New Bundles on Schedule,” HFMA Weekly, February 24, 2017)
Concerns about delay or even elimination of the mandatory models persist. The new secretary of HHS, Tom Price, has criticized mandatory bundles, and even though the recent delay was credited to the January executive order, some industry advisers noted that it occurred shortly after Price’s arrival at HHS. They are watching for further rulemaking or formal confirmation regarding the new models by March 21, the end of the 60-day time frame in the executive order.
However, one industry expert noted, “all of the indications that have been publicly put out so far…attest to the fact that the plan is to move forward with implementation.” (“Despite Provision Delay, New Bundles on Schedule,” HFMA Weekly, February 24, 2017)
The American Hospital is on record with its preferences: writing in a recent press release: the AMI and CABG models are “too much, too soon . . . we remain very concerned about several key issues, particularly the pace of change . . . While it is important to test new payment models, hospitals should not be forced to participate in complicated new programs if the government has not already proven that they will benefit the patients we serve. We will continue to urge that any new bundled payment programs be of a voluntary nature.” (Statement on CMS’ New Bundled Payments for Cardiac Care and Hip Fractures Final Rule, AHA Press Release, December 2016)
Hospitals designated for the new models have taken a wait-and-see approach, according to one expert. They are waiting for formal confirmation that the models will continue and for historical data from CMS on their past performance, against which they will be graded in the new model, he said.
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