CMS eyes bundled payment pilot for specialist physicians


The initiative would expand Medicare’s present Bundled Payments for Care Improvement (BPCI) program


Work is underway at the Centers for Medicare & Medicaid Services (CMS) on development of pilot projects to test episode-based reimbursement for medical specialists in outpatient settings. The CMS Center for Medicare and Medicaid Innovation (CMMI) plans to develop the new bundled payment projects under authority granted in the Affordable Care Act to test new payment and care models under the Medicare, Medicaid and the Children’s Health Insurance Program. The initiative would essentially expand Medicare’s present Bundled Payments for Care Improvement (BPCI) program, which now covers primarily inpatient hospital services. It would mark the first time CMS has targeted a bundled payment program toward individual physicians, rather than institutions. The CMMI is planning to develop bundled specialist payment programs for:

Procedures, including common outpatients surgeries (such as colonoscopy or cataract removal) and nonsurgical treatments (such as radiation therapy), which might require specialist services care for a period of days or weeks; and 

Management of complex or chronic diseases (such as an ongoing cardiac condition), which could require a specialist to work with a primary care physician to provide care over an extended period of time.

The new specialist bundled payment models would be distinct from the new payments for chronic care management slated to begin in 2015 through the Medicare Physician Fee Schedule. In February, CMMI issued a request for information on bundled payment opportunities for specialists, including specific conditions, existing models and specific quality metrics. The agency also asked for information on factors that might encourage or discourage specialists from participating in bundled payment programs.

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