CMS announced in August that it proposes canceling the Advancing Care Coordination Through Episode Payment Models (EPMs) and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule also seeks to make participation in the Comprehensive Care for Joint Replacement (CJR) model voluntary in 33 of the 67 geographic areas where it’s now mandatory. This is in addition to two announcements earlier this year postponing amendments to the CJR and the start dates of its five-year demonstration programs.
The proposed cancellation of mandatory bundles from CMS is a great indicator that voluntary bundles will be announced imminently, says Carter Paine, chief operating officer at Newton, Massachusetts-based naviHealth, which develops software for care transitions. His reasoning? CMS and the Center for Medicare and Medicaid Innovation (CMMI) recognize bundled payments’ value and support their expansion in response to market demand.
Paine says that the next iteration of Bundled Payments for Care Improvements (BPCI) will likely qualify as an Advanced Alternative Payment Model under MACRA, which creates an opportunity for hospital-based specialists and surgeons.
“The approaching BPCI model creates a compelling physician alignment opportunity for health systems that are seeking to establish better relationships with these high-value providers,” he says.
CMS’ proposal to move away from mandatory bundled payments hasn’t dampened private payers’ interest in such models, and physicians and health systems need to prepare. Here’s how to thrive in such arrangements, whether through partnerships with CMS or with private payers.
Determine cost variations
With any bundle, the most important thing is to figure out the biggest cause of variation that’s associated with a big dollar amount, says Anne Wong, a director with strategy&, a consulting firm that’s part of the PwC family of companies. “Once you crack that nut, you’ll be able to be successful with bundles,” she says.
For example, readmissions can contribute to the high costs associated with coronary artery bypass grafting (CABG), says Wong. Thus, rehabilitation should be as standardized as possible, which means healthcare providers should study their care pathways and look at the different drivers of cost and variability.