The Centers for Medicare & Medicaid Services’ proposal to bundle payments for hip and knee replacements is “premature,” according to comments from the American Health Care Association submitted to federal regulators.

“While AHCA supports the concept of bundled payments generally, we believe it is too early for CMS to propose a mandatory model and too premature to design a model with the hospital as the bundle owner,” wrote AHCA Senior Vice President Mike Cheek in a letter to CMS.

Cheek cites provider concerns that they’ll be “locked out” of the new system should it be put in place. He suggests two modifications to the bundled payment model in the letter: ensuring the model protects beneficiaries’ freedom of choice by not granting any waivers to allow hospital steering or closed networks, and not tying a facility’s use of a waiver of the three-day rule to its Five-Star rating.

The American Hospital Association also chimed in with its own comments on the proposal this week, saying it supports the model but asks that CMS to waive the Physician Self-Referral Law and Anti-Kickback Statute.

“As proposed, any financial arrangement or agreement under the CCJR model that implicates fraud and abuse laws would not be protected unless it falls under an existing exception or safe harbor,” wrote AHA Executive Vice President Tom Nickels. “That is an unacceptable risk for hospitals, whose participation in this program would be mandatory.”

AHA also requested CMS to delay the proposed start date in order to give hospital “adequate time to put in place the care processes and procedures necessary to achieve success in this program.”

LeadingAge also submitted comments to CMS regarding the bundled payment proposal, asking that the agency ensure that “bundling does not incentivize providers” to only select patients with the best chance of quick, inexpensive recoveries. LeadingAge also asked that the Five-Star system not be used to determine which facilities could best handle joint replacement patients, since the system only includes one measure that could apply to those patients.