Mandatory bundled payment programs could be stopped
HHS is proposing to eliminate some mandatory bundled payment programs, including those for heart attacks and those for hip and femur fractures, according to a rule title posted late last week.

UPDATE: The CMS released the proposed rule on Tuesday. The proposal reduces the number of mandatory geographic areas for the joint bundled payment program and cancels the cardiac bundled payment program model.

In reaction to the cancellation of the cardiac bundled payment program, American College of Cardiology President Dr. Mary Norine Walsh stated, “The [ACC] will continue to work with CMS on opportunities for clinicians to participate meaningfully in Advanced Alternative Payment Models. As we move from volume-based care to value-based care, the path forward is challenging and we must work together to find solutions.”

Dive Brief:

HHS is proposing to eliminate some mandatory bundled payment programs, including those for heart attacks and those for hip and femur fractures, according to a rule title posted late last week.

The bundled payment programs have been delayed multiple times, and the cardiac bundled payment program was set to begin in January 2018.

Eliminating the bundling programs would also remove one of the ways providers can qualify for MACRA’s 5% advanced payment model bonus, Axios reported.

Dive Insight:

The attempt to stop the programs isn’t much of a surprise, considering the frequent delays and HHS Secretary Tom Price’s multiple statements criticizing mandatory bundling programs. Price has said the programs are high-risk and take needed flexibility away from providers.

The American Hospital Association has resisted the mandatory programs, saying they are moving too quickly and have not been tested enough. The organization isn’t opposed to bundled payment in general, but many policy experts say the programs need to be mandatory for systemic change to be achieved, and for reliable research on the results. Those results have been mixed so far, but are mostly positive. Bundled payments have been shown to reduce costs without sacrificing care quality.

The bundled payment programs were a product of the Center for Medicare and Medicaid Innovation, which recently lost its director, Patrick Conway, to Blue Cross Blue Shield of North Carolina.

Still, the model isn’t likely to go away, Archway CEO David Terry recently told Healthcare Dive. Bundled payments are positive for providers and aligns their interests with those of payers and patients, he said.

“In this scenario, acute care will ultimately constitute a smaller component than currently, so hospital payments could well shrink," he said. "However, if hospitals take the appropriate action they can sustain and even grow their bottom lines by more coordinated and prudent use of resources.”