ACC promises to work on APM opportunities after proposed cancellation of cardiac bundles

CMS confirmed Tuesday it has proposed to cancel two mandatory bundled payment programs, Episode Payment Models (EPMs) and the Cardiac Rehabilitation Incentive (CRI) payment model, closing a path for cardiologists to qualify for the 5 percent bonus in the Advanced Alternative Payment Models (AAPMs) payment track.

The move came after the new administration at CMS twice delayed the start date of the programs. Both HHS Secretary Tom Price, MD and CMS Administrator Seema Verma, MPH, have been critical of mandatory bundles in the past, and they were expected to seek to make participation in these programs voluntary.

Those predictions came true in a new proposed rule that would cancel EPMs and CRI, while halving the number of geographic areas where participation in the separate Comprehensive Care for Joint Replacement (CJR) model will be mandatory.

“Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” Verma said in a statement. “Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries.”

The proposed rule stated CMS considered retaining EPMs and CRI on a voluntary basis, but determined there wasn’t enough time to alter the model designs, payment methodologies, financial arrangements and quality measures in time for the Jan. 1, 2018 start date. CMS also signaled it won’t pursue further mandatory payment models, saying it “expects to increase opportunities for providers to participate in voluntary initiatives,” including future EPMs which wouldn’t require rulemaking.

“The Innovation Center expects to develop new voluntary bundled payment model(s) during CY 2018 that would be designed to meet the criteria to be an Advanced APM,” the rule said. “We also note the strong evidence base and other positive stakeholder feedback that we have received regarding (CRI). As we further develop the Innovation Center’s portfolio of models, we may revisit this model and will consider stakeholder feedback for a potential new voluntary initiative.”

The American College of Cardiology (ACC) had supported the concept of the now-canceled bundles and appeared focused on its effects on AAPM participation in a statement to Cardiovascular Business.

“The American College of Cardiology will continue to work with CMS on opportunities for clinicians to participate meaningfully in Advanced Alternative Payment Models,” said ACC President Mary Norine Walsh, MD. "As we move from volume-based care to value-based care, the path forward is challenging and we must work together to find solutions.”

Two major hospital groups offered differing opinions on the cancelation. Federation of American Hospitals President and CEO Chip Kahn supported it, saying to HealthExec he “welcomes Secretary Price’s thoughtful efforts to reduce the regulatory burden on providers.” FAH and others had argued mandatory participation in these programs was beyond CMS’ authority.

The American Hospital Association, however, had supported the mandatory bundles.

“We previously expressed to CMS that we support bundled payment models as programs that could help transform care delivery through improved care coordination and financial accountability. We are concerned that a mandatory cancellation of the cardiac and SHFFT programs may be disruptive to providers who have expended valuable resources to put these programs in place,” said Ashley Thompson, AHA’s senior vice president for public policy analysis and development.