More mandatory bundled payments may be coming: analysis

CMS may consider more mandatory bundled payment programs in the future, Seidman says
CMS may consider more mandatory bundled payment programs in the future, Seidman says

The drop in providers participating in the Centers for Medicare & Medicaid Services' bundled payment pilot program could spur the agency to create more mandatory bundled payment programs, according to an analysis released Monday.

Just 25% of the providers who originally showed interest in participating in CMS' voluntary Bundled Payment for Care Improvement program, the analysis by Avalere Health shows. That drop, to only 1,500 providers now taking part, could mean CMS will turn to more mandatory programs, like the Comprehensive Care for Joint Replacement program analysts said.

“The fact that many providers that entered the program decided it's not currently in their financial interest to accept downside risk may cause CMS to consider additional mandatory programs in the future,” said Josh Seidman, senior vice president at Avalere.

Skilled nursing facilities led the pack of healthcare providers participating in the program as of October 2015, representing 46.6% of providers. Hospitals ranked as the second largest provider type at 27%.

The voluntary BPCI program allows providers to choose which care episodes they want to test bundled payments for from a list of 48 clinical conditions, including sepsis, joint replacement and respiratory infection. The providers still in the program test nine conditions on average, Avalere found. The most popular conditions are lower extremity joint replacements, pneumonia, chronic obstructive pulmonary disease and congestive heart failure.

Close to 15% of the participants  are testing more than 20 conditions — a good sign, Seidman said, as it “shows providers' willingness to test new alternative payment models.”

To read the full Avalere analysis, click here.