Viewpoint: Medicare bundled payments should remain mandatory

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In a blog post published in Health Affairs, fellows at the research and policy group Brookings Institution argue HHS and CMS should not make Medicare bundled payments for hip and knee replacements, hip fractures, bypass surgery and heart attack optional.

In the past, HHS Secretary Tom Price, MD, has expressed skepticism about the models' requirement that all providers in a certain geographical area must participate in the program. In addition, CMS issued an interim final rule delaying both implementation of cardiac care bundled payment initiatives and expansion of the existing Comprehensive Care for Joint Replacement model. These moves "raise some questions as to whether HHS will proceed with the program under its current structure," the fellows write.

While the authors acknowledge "there is some scope to modify these models to address concerns raised by Secretary Price and others without damaging the integrity of the models," they said "making these models optional would eliminate the ability to generate robust evidence on their effectiveness."

The fellows stated voluntary payment models, like the 2013 Bundled Payments for Care Improvement Initiative, have highlighted "important weaknesses" of voluntary programs, like limited size and selective participation. They said mandatory models, like CJR and Cardiac Bundles, can lead to more care efficiency improvements.   

The authors concluded "the Department does not have a good alternative to the mandatory structure used for CJR and EPM that could preserve the integrity of the models tests and the scope of their potential impact. Making these models optional would be a severe blow to efforts to use bundled payments to improve care delivery in orthopedics and cardiac care, and to the chances for bringing bundled payments to scale nationally in the coming years."

For the full Health Affairs blog post by the Brookings fellows, click here.  

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