Financial

Despite federal delays, bundled payments will be entrenched in US healthcare

AUTHOR Les Masterson/July 17, 2017

Amid yet another delay in CMS-led bundled payment programs, the popular value-based reimbursement model seems poised to continue as a favorite for providers. Bundled payments serve as an entry to value-based care because of the relatively low risk providers take on. And while these programs aren’t yet proven to be successful, there is enough positive data to excite those who champion paying for healthcare based on value.

Bundled payment models have been around for decades, but they really started to grow as President Barack Obama took office and the CMS started to role out demonstration projects and other initiatives. Although CMS under the current administration is less enthused for bundled payments, the industry trend isn’t likely to stop.

Private payers are getting in the game, too, so hospitals should invest in EHRs that allow real-time care coordination, and should consider trying voluntary programs as an on ramp to the process.

More delays

CMS in recent months has delayed starting and expanding bundled payment programs that would further move payments from fee-for-service (FFS) to a value-based system. The delays have caused concerns in the industry, but CMS said they allow for additional review and feedback from the industry.

The federal agency has also delayed the start of some programs to next year as well as put a pause on expanding others. These weren’t CMS’ first bundled payment program delays.

The American Hospital Association supported the delay in April, but spoke out against additional delays and potential burdens on providers. “As it exists, the rule places too much risk on providers with little opportunity for reward in the form of shared savings, especially in light of the significant upfront investments required,” said AHA Executive Vice President Tom Nickels.

Recent delays are particularly concerning because HHS Secretary Dr. Tom Price has been a vocal critic of mandatory bundled payment programs. Still, Price supports voluntary programs and backed the bipartisan Medicare Access and CHIP Reauthorization ACT (MACRA) when he was in Congress.

 

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Drue De Angelis

Drue is Managing Partner for The De Angelis Group, Executive Search firm exclusively for the Ortho & Spine industry.

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