CMS cancels cardiac bundles, scales back CJR model: 8 things to know

CMS issued a proposed rule Tuesday that would cancel or scale back major bundled payment initiatives.

Here are eight things to know about the proposed rule.  

1. CMS sent a proposed rule to the Office of Management and Budget last week. The title of the rule indicated CMS would cancel mandatory bundled payment initiatives for heart attacks, bypass surgery and hip and femur fractures. Details on the changes were revealed Tuesday when the proposed rule was made public.

2. The proposed rule would cancel the mandatory bundled payment program for heart attacks and bypass surgeries and the cardiac rehabilitation payment model, which is intended to test whether a payment incentive can increase the utilization of cardiac rehabilitative services.

3. The proposed rule would eliminate mandatory bundling for hip and femur fracture treatment under the Comprehensive Care for Joint Replacement program. 

4. The cardiac bundled payment models and expansion of the CJR program are slated to begin Jan. 1, 2018.

5. The proposed rule would scale back the existing CJR model. Under the proposed rule, the CJR program would be mandatory for hospitals in 34 of the 67 geographic areas chosen for the program. The CJR model would continue on a voluntarily basis in the other 33 geographic areas. The proposed rule would also make participating in the CJR model voluntary for all low volume and rural hospitals in the 67 areas.

6. "Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals," said CMS Administrator Seema Verma. "Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries."

7. Ashley Thompson, American Hospital Association senior vice president for public policy analysis and development, said the AHA is concerned cancellation of the bundled payment models could cause problems for provider organizations that have spent valuable resources to implement these programs.

8. CMS will accept comments on the proposed rule until Oct. 16.

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