News: Hospitals support goals of bundled payment, but concerned about pace, says AHA

Nearly 5,000 member hospitals, health systems, and other healthcare organizations say they are on board for CMS’ Cardiac and Comprehensive Care for Joint Replacement (CJR) Bundled Payment Model proposed rule. Groups expressed concern, however, about the  pace of change, and CMS’ ability to accurately track and process the outcomes of its increasingly complex alternative payment models, according to a letter written by the American Hospital Association (AHA) to Andrew Slavitt, acting administrator for CMS.

As CMS transitions from volume to value-based payments and alternative payment models, including bundled payment models, it set  the goal to have 30% of payments tied to APMs by 2016, and 50% of its payments tied to APMs by 2018, according to Cheryl Ericson, MS, RN, CCDS, CDIP, manager of clinical documentation services with DHG Healthcare, who spoke on the subject in a recent edition of ACDIS Radio. Bundled payments fall under two categories:

1. elective/voluntary
2. mandatory

Initially, the Bundled Payments for Care Initiative (BPCI), launched in 2013, was a voluntary program (hospitals could sign up to participate). However, participation wasn’t as high as CMS anticipated, so , the agency implemented mandatory bundled payments, including CJR. CMS picked 67 metropolitan statistical areas and required hospitals in those regions not involved in a BCCI to participate.

In its letter, the AHA urged CMS to refrain from expanding mandatory bundled payment models to other geographic areas or clinical conditions before conducting an assessment of lessons learned under existing models. AHA expressed particular concern with CMS’ proposed cardiac bundled payment model, which came less than four months after the CJR program began and with measures almost exactly the same as the CJR. CMS does not have any complete episode data and has not been able to effectively evaluate how bundled payments are working, says the AHA.

The proposed cardiac rule sets at least 75 different target prices for different combinations of cardiac diagnoses and procedures, posing challenges for providers and other clinicians. CMS should move at a more deliberate pace and simplify the rule, and perhaps consider including only coronary artery bypass grafts (CABGs) in the cardiac model to start, the AHA wrote.

In addition, the AHA does not support CMS’s proposal to expand the CJR program to include surgical hip and femur fracture treatment (SHFFT) episodes, or to require certain CJR hospitals to also implement the cardiac bundled payment model. Hospitals do not have an unlimited capacity to implement bundled payment models, and individual organizations need an opportunity to see how bundled payments effect their facilities, says the AHA.