CMS Announces Changes to Mandatory Bundled Payment Programs

CMS recently submitted a proposal to cancel the mandatory cardiac bundle, affecting heart attacks and bypass surgeries, hip/femur fracture treatment, and scaling back the joint replacement bundle (CJR). The bundles have been delayed twice and were most recently slated to start on January 1st, 2018.

The rolling back of the program is consistent with Secretary Tom Price’s stance on shift bundled payments towards the voluntary models only. In speaking with John Banks Powell, CipherHealth’s VP of Post-Acute Strategy, we explored the impact these changes may have on patient care and healthcare reform in the United states.

How do you feel about the changes to the mandatory bundled payments programs?

    “While I am personally a bit surprised that CMS has proposed to fully cancel some of these programs, I am glad to see that there is still a focus on expanding the voluntary bundles under the current BPCI program. Also, the capitated nature of episode-based payment models has created a different thought process that has proven to cut wasted spending out of the system. This is the type of thinking bundled payments create, and why I think the ball will continue to roll in that direction, regardless of what we call them.”

Do you feel this is a setback for creating patient-centered care models?

    “I think that the roll-back of the mandatory CJR model poses both positives and negatives. Under the voluntary BPCI models, it seems that providers are less hospital-centric and the decision-making process is much tougher. That said, by making the program a more voluntary endeavor, ideally, CMS will be attracting more innovative provider systems committed to putting new processes and technologies in place to achieve success. It is also important to point out that CMS is not fully cutting the cord on mandatory bundles and the remaining 34 mandatory MSAs for CJR are the ones with the highest historical episodic payments for THA/TKA.”

How can technology help those still a part of the mandatory or voluntary bundles?

    “Technology plays a critical role in any type of bundled payments. You need to be able to coordinate care efficiently across many settings while also engaging patients throughout their entire episodes. These are challenging tasks and the EMR is not the solution, instead, providers should look to implement single platform technologies that can meet multiple goals, such as higher patient engagement and better care coordination across provider teams. Irrespective of payment model, these types of technology will produce better patient care and a more efficient care delivery model.”

As value-based care continues to evolve, providers will need to consider how to set themselves up for success in future programs.

Learn more about CipherHealth’s bundled payment solutions.

CipherHealth empowers providers across the care continuum to deliver enhanced patient experiences and communications through a modular, comprehensive patient engagement technology platform.