CMS has released the text of the proposed rule with regard to bundled payment status (see my post from earlier today). The link is here – https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-17446.pdf
In summary, here are the high points.
- No advance of the cardiac and upper femur fracture/traumatic joint repair/replace bundles for 2018. The reason? As stated in my earlier post. Lack of consensus on the part of the hospital and provider community in terms of rate and structural episode accuracy is the major cause of collapse. The complexity to convert crossing DRGs into one episode payment across multiple physician providers was simply too much.
- With the end of the cardiac bundles, it appears that the cardiac rehab incentive payments have entered limbo. We’ll await additional rule-making for more guidance and possible restoration.
- On the existing hip and knee replacement bundles (aka CJR) that are in-effect and mandatory in 67 MSAs, CMS is proposing to cut the mandatory MSA participation in half (34 to remain). The remaining 34 MSAs are per CMS, higher cost areas that may show efficiencies and care improvements over-time. Recall in my earlier post that this is one of the problematic elements regarding BPCI – no real evidence of savings and improvement overall.
- Finally, CMS will give participation flexibility to low volume hospitals and rural hospitals in the remaining CJR mandatory MSAs.
In closing, text in-hand, the news earlier is confirmed and pretty much as expected. CMS is proffering language around renewed flexibilities, commitment to engage providers and more voluntary models as the future. At least for now, mandatory and expanded bundled/episode payment models are on semi-permanent hiatus.
