CMS Proposes Scaling Back Mandatory Bundled Payments

On August 15, the Centers for Medicare & Medicaid Services (CMS) announced a proposal to scale back mandatory bundled payments. This proposal includes cancellation of Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, and changes to the Comprehensive Care for Joint Replacement (CJR) model. The EPM and CR incentive payment models were originally scheduled to begin on Jan. 1, 2018.

CMS stated in a press release that the elimination of EPMs and CR incentive payment models would give the agency “greater flexibility to design and test innovations that will improve quality and care coordination across the inpatient and post-acute-care spectrum.” The press release also indicated that CMS expects to make many EPMs voluntary in the future.

The proposed rule also includes revisions to certain aspects of the Comprehensive Care for Joint Replacement (CJR) model, specifically proposing to make participation voluntary for eligible hospitals in approximately half of the geographic areas selected for participation in the CJR model and giving certain hospitals a one-time choice to continue participation. The CJR model would continue on a mandatory basis in the other selected geographic areas, with exceptions for low volume and rural hospitals. CMS is proposing that any hospitals eligible for voluntary participation that do not elect to participate will have all their performance year 3 episodes (i.e., those episodes ending on or after January 1, 2018, and before January 1, 2019) canceled.

The proposed rule is available here and is open for public comment through October 16, 2017. Aegis Therapies is currently reviewing this proposal and will be submitting comments.

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