by Shoshana Krilow, Vice President, Public Policy and Government Relations

Admit it. You thought I was going somewhere else with that, didn’t you? To be fair, the agency did say it disagreed “with commenters who suggested that CMS withdraw these models altogether …”

However, in accordance with the Centers for Medicare & Medicaid Services (CMS) mandate to limit new regulations, and in accordance with the administration’s views that mandatory participation in bundled payment programs is overly burdensome, CMS has now officially proposed cancelling several new bundled payment programs and limiting the scope of one already underway.

The Vizient Office of Public Policy has prepared a summary of the proposed rule, which does allow for a 60-day comment period. But with the recent announcement of the soon-to-be-departed Dr. Patrick Conway from the Center for Medicare and Medicaid Innovation (CMMI), and Secretary Price’s well-known distaste for mandatory participation, our guess is that this rule will be finalized to reflect (almost) exactly what it is proposing to do.

So, what exactly is that, you ask?

First, CMS is proposing to eliminate three new episode payment models (EPMs) and a cardiac rehabilitation (CR) incentive payment model. The EPMs were for acute myocardial infarction, coronary artery bypass graft and surgical hip/knee fracture treatment. The agency previously finalized but delayed these new payment models, which were set to go into effect on Jan. 1, 2018.  Rather than delay indefinitely, which they promised not to do, CMS chose to rescind them entirely, primarily because they felt the programs needed to be more fully developed and that the mandatory nature of the programs would hinder their ability to engage providers on a voluntary basis in the future.

Additionally, CMS is proposing to reduce the scope of the comprehensive care for joint replacement model (CJR) from 67 required metropolitan statistical areas (MSAs) to 34 mandatory MSAs and 33 voluntary ones. Low-volume and rural hospitals would be exempt entirely from mandatory participation.

Now I bet you’re wondering what this means for the future of value-based care?

We have long expected and predicted that CMMI would begin to move more slowly on new initiatives, including bundled payment programs. This proposed rule is aligned with that expectation. However, Vizient is acutely aware of the work that has gone into preparing for the EPMs. We fully intend to make sure CMS knows their belief that this proposed rule will not “cost” providers anything may be inaccurate. We encourage you to tell them – and us – what the cost and impact of this proposed rule may be on your institutions. 

That said, we feel confident CMS understands the value of moving away from fee-for-service and toward value-based care. But, with new leadership throughout the agency, including at CMMI, we expect their pace toward value-based care will be slower.

However, word to the wise, any efforts that are currently underway that help providers increase efficiencies, lower costs and enhance quality of care should continue ... as CMS is likely not too far behind in supporting those efforts.  

And, as my in-the-know colleague recently said, “Just because ‘voluntold’ payment models seem to be falling out of fashion, it doesn’t mean voluntary ones aren’t in the future.”

About the author. As vice president of public policy and government relations, Krilow leads Vizient’s government relations, monitoring federal legislative and regulatory developments of importance to Vizient and its members. She has worked as a strategic advisor to health sector clients with a particular concentration on Medicare, the pharmaceutical and insurance industries, and the Affordable Care Act. Krilow also brings deep legislative expertise having spent several years on Capitol Hill, where she worked as a health policy advisor for Representative Marion Berry (D-Ark.) and Senator Joseph Lieberman (I-Conn.).

Published: August 17, 2017