Skilled nursing facilities see opportunity as CMS finalizes cancellation of bundled pay models

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The Centers for Medicare & Medicaid Services on Thursday finalized its previously announced cancellation of mandatory bundled payment models for hip fractures and cardiac care, as well as changes to its Comprehensive Care for Joint Replacement model.

Giving the mandatory models the ax doesn't mean the agency is shying away from bundled payment models entirely, CMS Administrator Seema Verma said in a statement. She noted that new voluntary initiatives and opportunities for provider engagement are on the horizon.

“While CMS continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care,” Verma said.

Dropping the new cardiac and hip fracture models will give CMS more flexibility to design and test new innovations, the agency said.

Among the finalized CJR changes is a reduction in the mandatory number of geographic areas participating in the model, from 67 to 34. Low-volume and rural hospitals in all of the program's geographic areas are also offered voluntary participation to accommodate their “unique needs,” CMS said.

Keely Macmillan, general manager of BCPI for Archway Health, told McKnight's Long-Term Care News that the announcement is “great news for nursing home providers,” since it solidifies CMS' commitment to voluntary initiatives.

“This really clears the way for SNFs to be engaged in these voluntary programs,” Macmillan said.

As far as future voluntary models, Macmillan predicts more diversification in the type of provider that can own the bundle, as well as bundles that “engage a broader provider community” and incorporate outpatient or ambulatory episodes.

“Our advice to providers, where it's SNFs or other types, is to apply to these programs,” encouraged Dave Terry, CEO of Archway Health. “You get a tremendous amount of data to look at and see how you compare to others in your market, and where your opportunities are for improvement. Just look and see how you might improve outcomes … there's no downside to getting that information.”