CMS Bundled Payment Changes Untenable?

Karen Minich-Pourshadi, December 10, 2012

Recently, the Centers for Medicare & Medicaid Innovation (CMMI) announced changes to its Bundled Payment Care Improvement Initiative that could make pursuing its model untenable and even cause some applicants to drop out of the program, according to a CMS reviewer of bundled payment applications.

But is dropping out really an option? Bundled payments are multifaceted, and regardless of the payer—commercial or governmental—it is the payment model of the future. So what did CMS change that's cause for consternation?

Although some of the CMS changes will ease bundled payment execution, such as standardizing episodes, discounts, and readmission exclusions, others will shift more risk onto participants, such as the broader definition of related readmission to include all medical DRGs. The latter may prove too much for some providers, says Deirdre Baggot, MBA, RN, who is vice president with healthcare consultancy The Camden Group and an expert panelist for CMS bundled payment applications.

"Payment reform is actually care reform, so to make it work you have to first reform the way you deliver care. But you also need to understand the risk," says Baggot.

Karen Minich-Pourshadi Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media. Twitter

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