New bundled pay changes could jeopardize Medicare funding, experts warn

Share this content:

Recent proposals to cancel or change some of the Centers for Medicare & Medicaid Services' bundled payment initiatives may end up hurting care quality, increasing Medicare costs and stalling the agency's move to value-based care, experts are warning.

CMS plans to cancel the recently finalized Episode Payment and Cardiac Rehabilitation models in their entirety. It also wants to drop the number of mandatory participation areas for its Comprehensive Care for Joint Replacement model from 67 to 34.

That's a bad move considering the progress the agency has made so far on value-based initiatives, according to some healthcare observers. The costs of changing the models would end up costing more than leaving them in place, which could serve as a blow to the Medicare Trust Fund, they say.

“Rather than cut back programs that the Congressional Budget Office has already determined would save taxpayers $250 billion over five years, it would make more sense to continue those programs while looking for new reimbursement approaches that would also deliver value,” Stephen Ondra, M.D., CEO of North Star Healthcare Consulting told Forbes.

A CMS spokesperson told Forbes that the changes to the joint replacement model would save Medicare $204 million, compared to the original $294 million estimated to be saved over the remaining performance period.

Brian Marcotte, president and CEO of the National Business Group on Health, noted that “anything that slows the momentum toward a value-based reimbursement system is a step backward.”

“We cannot sustain the unmitigated healthcare cost increases fueled by the perverse nature of fee-for-service,” Marcotte said. “It's just unsustainable.”