CMS delays cardiac bundled payment models by three months

CMS delayed the implementation date for its bundled payments for cardiac care from July 1 until Oct. 1. It also hinted that it could further delay the model until Jan. 1, 2018.

CMS disclosed the delay in the Federal Register on March 21.

The agency finalized the bundled payment models on Dec. 20, 2016. Under the bundled payment models for acute MI and CABG, approximately 1,120 acute care hospitals in 98 geographic areas will be financially accountable for the quality and cost of an episode of care beginning with a hospitalization and extending for 90 days following hospital discharge.

CMS also introduced a cardiac rehabilitation incentive payment model in 45 geographic areas that are selected for the acute MI and CABG models, along with another 45 geographic areas that are not selected for those models.

The programs were scheduled to start on July 1 run through 2021. Now, the programs will not begin until Oct. 1 at the earliest.

“This additional three-month delay is necessary to allow time for additional review, to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps due to the rule taking effect for a short duration before any potential modifications are effectuated,” CMS said. “We note that, in light of this potential need for further notice and comment rulemaking prior to the start of the models, it would be problematic not to adjust the start date for [episode payment models] from July 1, 2017. Given the need for advanced notice of the terms of the models by participants, and the fact that the episodes in the models involved exceed 90 days in duration, we believe that immediately moving the start date of the model to October 1, 2017, is appropriate.”

CMS also said that the initial payments were originally scheduled to cover from July 1 through Dec. 31 this year and that subsequent payments would cover a full, 12-month calendar year. With the models now delayed until Oct. 1, CMS said it would still prefer to have the initial payment period last at least six months. Thus, it is seeking comments on delaying the models until Jan. 2018.

“If we effectuate any additional delay in the model start date, we also would delay the effective date of the conforming [comprehensive care for joint replacement model] regulation changes so that the effective date of those changes remains aligned with the applicability (model start) date of the [episode payment models],” CMS said.

Seema Verma, the new CMS administrator under President Donald Trump, said during her confirmation hearing before the Senate Finance Committee in February that she preferred a gradual expansion of new payment models.

“We need to make sure we’re not forcing, not mandating individuals to participate in an experiment, a trial that there’s not consent around,” Verma said.

Tom Price, President Trump’s pick for HHS Secretary, has also been a critic of bundled payments. However, Archway Health CEO Dave Terry said in an interview with HealthExec in January that he anticipated the programs would continue as voluntary initiatives.