CMS Delays Bundled Payment Expansion. What does it mean for you?

Tamara Cull Tamara Cull
Vice President, Market Development

Did you see the news? This week, CMS announced that it’s delaying expansion of the Comprehensive Care for Joint Replacement (CJR) program. It’s also postponing the start of the new Episode Payment Model, which includes the Acute Myocardial Infarction (AMI) Model, the Coronary Artery Bypass Graft (CABG) Model, the Surgical Hip and Femur Fracture Treatment (SHFFT) Model, and the Cardiac Rehabilitation (CR) Incentive Payment Model. Programs are on hold until at least October 1.

With new teams in charge at CMS under the new administration, the delays aren’t necessarily surprising. What’s important to note is the move to delay, rather than cancel, the programs. It shows CMS’ intent to move forward with bundled payments.

Per an interim final ruling issued March 21, CMS officials want more time to review the policies and solicit input from providers. Once they receive and assess open comments, they’ll announce the official start dates for both programs, with the possibility of a push until January 1, 2018.

What does this mean for providers?
To us, this move is a positive one: CMS wants to ensure providers understand the models and the complexity of the care redesign that goes along with them. CMS knows providers need time to successfully introduce this into their organizations. The delay gives providers breathing room to operationalize their efforts.

Those already preparing will have more time to “practice,” gaining the necessary experience to succeed at the population health efforts to follow. That “practice” can also lead to significant internal cost savings through implementation efforts while waiting for the possible payer savings from the CMS programs to start.

Bottom line: Like the broader value-based care picture, bundled payments are here to stay. Providers should proactively continue preparing for mandatory and voluntary bundled payment programs. They should seek opportunities to redesign care processes by:

  • Putting tools, technology, and people in place to manage patient populations that drive improved clinical and financial outcomes based on specific bundles.
  • Simplifying care coordination throughout the 90-day required care continuum.
  • Choosing care plan options with the most value at the least cost.
  • Enabling care managers to follow a patient’s progress through a prescribed treatment, then track against the care plan, risk models, and expected costs.

Because of the extra time, CMS will likely expect providers to be ready on day one, so expect the financial risk to start earlier in the new rollout of these programs. Providers who make strategic use of the extra preparation time will be best positioned to navigate the clinical and financial risk associated with bundled payment models.

Watch a recorded version of my Achieving Triple Aim Success in Bundled Payment Models Webinar.

Source: CMS announcement

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