CMS Finalizes Rule Scaling Back Expansion of Bundled Payments

Suggesting that the agency is positioning itself to better implement voluntary bundled payment arrangements, the Centers for Medicare and Medicaid Services (CMS) published a final rule last week scrapping three new mandatory Medicare Episode Payment Models and a Cardiac Rehabilitation Incentive Payment model scheduled for Jan. 1, 2018. The final rule also reduces the number of geographic areas in which hospitals are required to participate in the Comprehensive Care for Joint Replacement (CJR) program from 67 to 34.

Prior to this change, the CJR model required hospitals to participate in episodic payments for lower-extremity joint replacements (LEJRs) performed on Medicare fee-for-service beneficiaries in 14 counties in New York: Dutchess, Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester, Erie, and Niagara. CJR will remain mandatory for most hospitals in downstate counties but become optional for those in Erie and Niagara counties. Participation also becomes optional for several hospitals deemed to be low-volume hospitals even though they are located in otherwise mandatory counties. These facilities are listed in the final rule.

The three new bundles that are not being implemented were for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip/femur fracture. The 14 counties with mandatory CJR had been scheduled to expand to mandatory hip fracture bundles; hospitals in the Utica-Rome Metropolitan Statistical Area (MSA) would have had to implement mandatory AMI and CABG bundles.

The final rule fact sheet is available here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841