CMS proposed Monday a new mandatory bundled payment program for heart attacks and bypass surgeries. The proposed rule also includes an expansion of the Comprehensive Care for Joint Replacement Model to include hip and femur fractures.
This proposal is the latest from CMS aimed at redesigning Medicare fee-for-service. Here is how five industry experts reacted to the announcement.
1. Though the American Hospital Association's Tom Nickels, executive vice president of government relations and public policy, lauded CMS' work to redesign care and the new program's inclusion in the advanced alternative payment models under MACRA — the Medicare Access and CHIP Reauthorization Act — he said in a statement that the program could overload hospitals.
"The proposal to bundle payments for cardiac care is the third mandatory demonstration project from CMS in a little over a year. Further, the agency is layering this new program on hospitals already working to implement the mandatory hip and knee bundled payment model. CMS also is proposing to expand and further complicate the hip and knee program less than four months after it began and before evaluating its results. CMS is putting the success of these critical programs at risk. Hospitals are under a tremendous burden to help ensure these complex models work for patients."
2. Topher Spiro, vice president for health policy at the Center for American Progress — a progressive public policy institute — said in a statement he hopes the new bundled payment program will encourage other payers to adopt similar models.
" Bundled payments are an important tool of the Affordable Care Act. We hope that the previously adopted bundled payment model for orthopedic procedures and this one will catalyze other payers to adopt similar bundled payments."
3. Phil Newman, CEO of ViiMed, a telehealth company that offers a care coordination platform to support bundled payment models, said the program is a huge step toward higher quality care. "Since hospitals are responsible for the total cost and quality of care, this insight is critical in preventing complications and avoiding unnecessary costs…It's great to see this expansion of CJR to include hip and femur fractures, as well. What we've learned is that these can be even more complicated than hip and knee replacements, and can often lead to total replacement surgeries. We're humbled and honored to work with some of the industry's leading healthcare organizations to help solve their bundled payment challenges."
4. Susan Nedza, MD, senior vice president of clinical outcomes management at MPA Healthcare Solutions — an analytic healthcare consulting firm — said in a statement the proposed rule signals the push for alternative payment models will continue from both CMS and private payers.
"The financial health of hospitals will become increasingly tied to alternative payment models as these product lines — total joint replacement and cardiac care — represent a significant contribution to their bottom line. Effective and efficient care requires increasing efforts to align quality and financial incentives with physicians and post-acute care providers."
5. Michael Abrams, vice president and co-founder of Numerof and Associates, a healthcare management consultancy, said the extension of the bundled payment program to cardiac care was expected and is a step in the right direction.
"That said, this program does not give us the market based approach that we've advocated as the only real hope for a more patient-oriented delivery system. It's still top-down and relies on regulation rather than market mechanisms."
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