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Medicare Bundle Backlash is Brewing

News  |  By Christopher Cheney  
   December 22, 2016

Despite headwinds, Medicare officials are launching mandatory cardiac-care bundled payments and expanding similar episode-of-care reimbursement programs for orthopedic care.

The Centers for Medicare and Medicaid Services is forging ahead with efforts to expand mandatory bundled payment programs, but increasing resistance to the initiatives is adding uncertainty to the reform effort.

On December 20, CMS announced it will implement a trio of Medicare cardiac-care bundled payment programs beginning in July 2017: the Acute Myocardial Infarction (AMI) model, the Coronary Artery Bypass Graft (CABG) model, and the Cardiac Rehabilitation (CR) incentive payment model.

The cardiac-care bundled payments programs will be mandatory for hospitals in 98 markets nationwide.

CMS also unveiled a new episode-of-care model for the agency's Comprehensive Care for Joint Replacement (CJR) bundled payments program for orthopedic care.

The Surgical Hip and Femur Fracture Treatment (SHFFT) model expands CJR reimbursement for hip and knee replacement procedures to include payments for Medicare beneficiaries who undergo surgery for hip fractures.

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The AIM, CABG, CR and SHFFT bundled payments programs will follow the same implementation timeline: the first performance period for the new episode-of-care models will begin July 1, 2017, and the models are scheduled to operate through December 2021, according to the CMS website.

New Hurdles
As CMS presses the agency's campaign to expand Medicare's mandatory bundled payment programs, internal and external hurdles are looming in 2017.

Next year, internal opposition to mandatory bundled payment programs is likely to be most intense among the leadership of the Department of Health and Human Services (HHS), the Cabinet-level agency that oversees CMS.

President-elect Trump's nominee to lead HHS—Rep. Tom Price, MD, R-GA—has been among the fiercest congressional critics of mandatory bundled payments.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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