CMS Expands Joint Bundles, Finalizes Cardiac Bundles

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule creating mandatory bundled payment programs for cardiac conditions, and expanding the scope of an existing bundled payment program for joint replacement episodes.

These bundled payment programs are seen as an opportunity for home health providers, which can help hospitals control costs and quality for the patients involved. But there have been concerns, as well.

Powerful voices in the home health industry—including Kindred Healthcare (NYSE: KND) and the National Association for Home Care & Hospice (NAHC)—have said CMS is moving too aggressively with mandatory programs that have yet to be proven effective.

Incoming Health and Human Services Secretary Tom Price shares these concerns, and has been an outspoken critic of mandatory bundled payment programs. He may halt them soon after the Trump administration takes office in January.

“Expect anything CMS does at the 11th hour to be on a list for Price to consider killing upon confirmation,” Terry Haines, managing director and head of political analysis at Evercore ISI, an economic research firm, told Modern Healthcare.

The current leadership at CMS stands behind the programs. The concept is that hospitals in affected markets would be responsible for all the costs related to episodes of care for certain patients: those who have had heart attacks, bypass surgery, joint replacements, or surgeries to repair hip and femur fractures.

The programs should save money while improving care, according to CMS.

The home health opportunity comes from hospitals being incentivized to work more closely with post-acute providers—and potentially share incentive payments with them.

“As a practicing doctor, I know the importance of hospitals, doctors, nurses and others working together to support a patient from heart attack or surgery all the way through recovery. These bundled payment models support coordinated care and can reward clinicians through the Quality Payment Program,” said Patrick Conway, M.D., CMS acting principal deputy administrator, in a statement issued Tuesday.

Written by Tim Mullaney

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