Viewpoint: Trump administration's curtail of bundle payments 'misguided'

President Donald Trump's administration's move to cancel or scale back major bundled payment initiatives is "misguided," Bloomberg's editorial board wrote in an Oct. 9 op-ed.

On Aug. 15, CMS issued a proposed rule to cancel the mandatory bundled payment program for heart attacks and bypass surgeries and the cardiac rehabilitation payment model. The cardiac rehabilitation payment model aims to test whether a payment incentive can increase use of cardiac rehabilitative services. The proposed rule also would eliminate mandatory bundling for hip and femur fracture treatment under the Comprehensive Care for Joint Replacement program, as well as scale back the existing CJR model.

Bloomberg's editors argued there are two reasons why the actions are "misguided":

1. Bundled payments curb expenses while improving quality of care. They pointed to a 2017 study published in JAMA highlighting how bundled payments for joint replacement services lowered Medicare costs for San Antonio-based Baptist Health System by 21 percent without lowering patient outcomes.

"Administration officials say these Obama-era bundled payment programs unfairly limit choices for patients and doctors," the editors wrote. "But the only choices taken off the table are unnecessary ones. And since the government is paying, it has a responsibility to see that its money is spent wisely."

2. Voluntary bundled payment models allow providers to choose fee-for-service models. While Trump administration officials argue bundled payments should not be mandatory, the authors wrote fee-for-service models are not a well-liked option. The editorial board wrote CMS Administrator Seema Verma seeks "a system that holds providers accountable for outcomes," as she wrote in a Sept. 19 article in The Wall Street Journal.

"Verma says doctors and hospitals should be able to shape this system as they see fit. Perhaps some local hospitals or networks could be allowed to experiment — much as Vermont and other states have instituted other kinds of pay-for-performance measures," the editors added. "But CMS will still need to monitor progress and make sure medical costs come down."

Access the full op-ed here

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