Providers: Too soon to expand Medicare bundled payment models

Hospital and nursing home advocates say a new Medicare payment model for heart attack patients should be halted until more evidence that it will work is available.

The comment period for a proposed rule establishing a cardiac payment bundle and expanding a hip replacement model closed Monday. Advocates claim CMS hasn’t gauged the success of the knee and hip replacement model, before duplicating it for cardiac patients. The rule would also expand the joint replacement model, which launched in April, to include hip and femur fracture treatment.

{mosads}The cardiac model, known as a bundle, would be phased in starting in July. CMS aims to improve the quality and coordination of medical and surgical services through bundled payment models by reimbursing for an episode of care rather than each service along the way.

The American Hospital Association said it’s too soon to expand the joint replacement model or add new models, without evidence that bundles are working to improve care.

“Hospitals do not have an unlimited capacity to implement bundled payment models,” the association said in a 40-page comment letter. “Indeed, the proposal to expand [the joint replacement model] also was put forth less than four months after the program began. Neither CMS nor hospital participants have had the time or the data to be able to analyze any lessons learned, successes or failures.”

“We are generally supportive of bundled payment and of hospitals serving as episode initiators, but these new proposals go too far too fast,” the letter says.

The AHA questioned the agency’s ability to “accurately track and process the outcomes of its myriad increasingly complex alternative payment models.”

Multiple groups called for CMS also to delay the implementation date of the models. The American Health Care Association, representing nursing homes, asked the agency to put any proposed bundles on hold until 12 months of joint replacement data is formally evaluated and it can be ensured the model is not harmful to patients.

“There is no evidence of decrease in mortality related to the target conditions attributable to bundled payment initiatives,” AHCA said in a comment letter. “Evidence of impact on hospital readmission rates and [emergency room] visits rates is mixed.”

The Federation of American Hospitals also called for CMS to delay the cardiac bundle until at least January 2018. FAH called the multi-bundle roll out “unreasonable expectations and burden,” for participating hospitals to juggle “rapid and multiple changes” in the care delivery and payment.  

“We understand CMS’ urgency for healthcare delivery reform. However, in the expansion of the bundling demonstrations we need to get it right, be deliberative and avoid laying on too much, too fast,” said Chip Kahn, FAH president and CEO. “Community hospitals only have so much bandwidth for experimentation and we urge CMS to choose a voluntary path — not mandate hospitals to participate. And, we must provide time for evaluation of current models to assure that these complex changes for hospitals, physicians, and post-acute providers are appropriate when policy is scaled.”

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