CMS proposes changes to existing bundles
The Centers for Medicare & Medicaid Services (CMS) recently proposed changes to several bundled payment programs.
While the headlines have been catchy–CMS cancels cardiac bundles, scales back CJR model: 8 things to know–the definitive position is misleading. These programs have not been “canceled” yet, though their fate is essentially sealed.
Tom Price, the current Secretary for Health and Human Services, has previously made it known he opposes mandatory bundles. Now that he has the ability to shape the future of health care reform he is using that position to propose removing the mandatory bundles that the Center for Medicare & Medicaid Innovation (CMMI) recently created.
Specifically, the proposal includes the cancelation of several bundled payment models just finalized in December of 2016–the Episode Payment Models, as well as the scaling back of the Comprehensive Care Joint Replacement (CJR) Model created in 2015.
CMS: "The overarching Episode Payment Model framework is a collection of models ranging from cardiac bundles (the Acute Myocardial Infarction (AMI) Model, the Coronary Artery Bypass Graft (CABG) Model, and the Cardiac Rehabilitation (CR) Model)) as well as an alteration of the Comprehensive Care Joint Replacement (CJR) Model called the Surgical Hip and Femur Fracture Treatment (SHFFT) Model."
A mouthful for certain.
Changes at University of Utah Health
In short, nothing.*
We are not involved in any of the CMS bundles that are on the cancelation radar. Our MSA was not selected for either the Episode Payment Models or the CJR model when it was created.
It is interesting to see what Tom Price’s administration is focusing on, the reduction of CMS’s mandatory bundles, but from our standpoint the main question related to bundles is what will happen to mandatory bundles (our current bundles). Only time will tell.
*In the short-term, yes, this does not mean anything to us. But, in the long-term, it is an important policy shift since we will a) not be responding to mandatory bundles from CMS (at least during this administration), and b) may not have the opportunity to participate in voluntary (BPCI 2.0) bundles in the future.
Need a Refresher? Bundled Payments Explained:
A “bundle” places all of the care for a certain procedure, or series of procedures, into a single bucket. A bundle. The rationale for contracting for a bundle is threefold:
- Patients benefit from having a team of providers focused on improving care processes, which often result in reduced procedures, supplies, and transition time.
- Payers benefit from having a predetermined price they will pay for care, meaning they know the exact amount they will pay for an episode of care.
- Care providers benefit from knowing the predictable amount they will get paid for patient care, even if the costs associated with that care are less than the agreed-upon bundle amount.
When talking about bundles with both internal and external colleagues some of the first questions are “what bundles do we participate in?” and “how can we establish, or build, a bundle?”