Will Trump administration welcome CMS’ mandatory cardiac bundle?

CMS has announced a new rule affecting Medicare fee-for-service beneficiaries receiving services during three common conditions/procedures: acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment. 

Under the new initiative, hospitals in 98 markets would be financially responsible for the cost and quality of all care associated with bypass surgery and heart attacks. CMS also plans to expand the existing Comprehensive Care for Joint Replacement (CCJR) model to include surgeries repairing hip and femur fractures.

The five-year demonstration is set to take effect July 1, 2017. Industry watchers are waiting to see if the new administration-specifically Trump’s nominee for HHS secretary, Rep. Tom Price (R.-Ga.)- will welcome the initiative. Price has voiced opposition to bundled payments.

Keckley

“CMS is operating under the assumption that its demonstration programs, including Medicare Shared Savings, CCJR and the Bundled Payments for Care Improvement [BPCI] demonstrations will continue in the new administration on a voluntary basis,” says Paul Keckley, PhD, a provider of independent health research and policy analysis. “Bundled payments have been widely implemented on a voluntary basis across the acute sector, with notable savings-$864/episode-in the CCJR bundle.”

Price, an orthopedic surgeon, is inclined to see a more traditional role for physicians as “captains” of the ship and a more limited role for Medicare and other payers who wish to influence clinical judgment, Keckley says. “He supports greater price transparency for hospitals, expansion of high-deductible health plans and consumer protections. In all likelihood, he will direct Medicare to suspend mandating bundles in favor of market-driven adoption phased in over three to four years,” he says.

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Mandating bundled payments is not necessary given their savings potential, provided employers and insurers opt to incorporate them in their contracting on a shared risk basis with local providers, according to Keckley.

However, bundled payments encourage coordination of care, especially in the hand-offs between clinicians and between hospital discharge activity and post-acute providers, he believes.

“The majority of waste-cost savings-in bundled payments come from care coordination, especially handoffs between providers and poor patient care management in the post-acute settings,” Keckley says. “The new healthcare leaders in D.C. will likely encourage employers and insurers to use voluntary bundled payment models as a basis for competition between health systems and their physicians. They will push back from mandatory bundles in favor of a voluntary program.”