CJR, Bundled Payments, CMS, ACA, Mandatory Bundles,, cms delays

Medicare Underscores Its Focus on Voluntary Bundled Payment Models

The Federal Registrar

According to a Proposed Rule released on August 10, Medicare's next iteration of voluntary bundled payments will be an Advanced APM in 2018, opening the door for robust participation. The Proposed Rule, if implemented in January 2018, would cancel the Mandatory Cardiac Episode Payment Models and make participation voluntary in the Comprehensive Care for Joint Replacement model for half of selected Metropolitan Statistical Areas (MSAs) and for low-volume and rural hospitals.

The Proposed Rule echoes what we heard from CMS leaders in May and June. The next version of the Medicare bundled payment model, which CMS intends to launch in 2018, will serve as a catalyst for specialists and hospital-based physicians to meet the quality and financial demands of MACRA. Moreover, population health leaders can benefit from engaging specialists with bundled payments when patients experience acute episodes of care. We believe that the voluntary bundled payment model scheduled to be rolled out in 2018 will be critical for all organizations to consider as an essential component of their value-based strategy.

Medicare acknowledges in this Proposed Rule what Remedy has experienced over the past five years: large bundled payment programs are critical to success and systemic change in health care organizations. Models like BPCI and its successor in 2018 succeed because hospitals and physician groups can select broad sets of Clinical Episodes that span service lines and systems, creating a groundswell of change throughout the organization.

CMS solicited in the Proposed Rule comments on ways to ease the entry of providers into bundled payments. We hope that Medicare encourages more active collaboration between bundled payment participants and ACOs. There is not a single solution to the challenges of creating a more efficient and responsive healthcare system. Instead, Medicare should continue deploying concurrent, proven payment strategies. In this regard, we believe that bundled payment models and ACOs should and can co-exist.

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