MedPAC will recommend site-neutral payments, but not for strokes

The Centers for Medicare & Medicaid Services is planning to pull the plug on its recently released — and frequently delayed — bundled payment models for cardiac and orthopedic care.

That’s according to a proposed rule sent to the Office of Management and Budget that is currently pending regulatory review, according to the office’s website. The rule is titled “Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model.”

Healthcare experts were skeptical of the models’ future from the start. They were introduced during the final days of the Obama administration, and current Department of Health and Human Services’ Secretary Tom Price, M.D., previously tried as a lawmaker to stop CMS from making payment models mandatory.

Dave Terry, CEO of Archway Health, told McKnight’s on Monday that Price’s support of voluntary bundled payment programs led him to believe the program would eventually undergo changes.

“We certainly expected that there would be changes back when Tom Price was nominated to be Secretary of HHS,” Terry said. “We thought [the models] would probably be switched from mandatory to voluntary … but we didn’t think it would be eliminated, just because there is demand for these programs on the voluntary side.”

Chris Garcia, CEO of Remedy Partners, said his organization had forecasted similar hurdles due to the bundles’ mandatory nature, as well as how complex cardiac care can be.

“We were not surprised that the mandatory models were running into trouble. Cardiac care is very complicated,” he told McKnight’s. “So many specialists will touch a patient during a cardiac episode. We had heard from our cardiology partners and they said, ‘What are they talking about? This is crazy.’”

The models, finalized in December 2016, included three new cardiac care-focused bundled payment models, along with one new one for non-replacement surgery following a hip fracture. The rule also covered revisions to the Comprehensive Care for Joint Replacement Model, including changes to the bundle’s skilled nursing facility waiver.

The models were originally slated to begin in July, but provisions of the final rule — including the start date — were delayed multiple times over the past year to give the new administration a chance to review them. The new rule was sent to OMB on Thursday.

The amount of effort CMS has put into the models so far was really the only surprising aspect to the proposed cancelation, Garcia said.

“We knew CMS was working hard on this. They had gone through a number of revisions,” he said. “Then all of a sudden— boom! — out of nowhere it’s just going to be canceled.”

Despite the inclusion of “cancelation” in the proposed rule’s title, both Terry and Garcia said there has been talk that the proposal won’t entirely cancel the models, but instead make them voluntary. CMS may also roll it into the upcoming BPCI Advanced initiative, which Terry believes will still “move full speed ahead.”