Bill to Delay Joint Replacement Bundles Has Unlikely Path Forward

A bundled payment initiative from the Centers for Medicare & Medicaid Services (CMS) set to go into effect next month could be pushed back by two years, if a bill that proposes to delay the implementation gets approved.

The bill, dubbed the Healthy Inpatient Procedures (HIP) Act, would delay the Comprehensive Care for Joint Replacement (CJR) payment model until 2018 and could impact the 67 hospital locations and affiliated post-acute care partners named in the model.

Proponents of the bill say the CJR payment model is coming too soon for hospitals and other care providers to be prepared and poses enormous risk that could be costly.


“This new, mandatory payment model handed down from CMS comes with tremendous risk and complexity for patients and health care providers,” the bill’s sponsor Congressman Tom Price (R – Georgia) said in a prepared statement. “Rushing its implementation would be unreasonable and potentially detrimental to patients and their quality of care.”

The Congressman urged for a delay on the implementation to allow for more time for the health system to reviews its potential benefits and consequences.

“At the very least, a delay in implementation is warranted to give all involved time to better assess, review and weigh the impact and consequences of this proposal and more adequately prepare so patients are protected,” he said.


However, home health and home care industry groups have seen the bundled payment initiative as largely positive, with more opportunities to bring home health care providers into new partnerships. The National Association for Home Care & Hospice (NAHC) explicitly expressed favorable support for the model when CMS’ rule was finalized last fall. Some private duty home care providers are looking at bundled payments as a new platform to extend services and bring awareness to this type of care.

Other bundled payment models are already underway with home health care partners. CMS began its bundled payment initiatives in 2013.

Another sponsor of the bill, Congressman David Scott (D – Georgia) agreed that a delay on implementation would leave physicians in a better place to prepare for the initiative.

“With the current health system rapidly evolving to address the changing nature of patient care, physicians need time to adjust to changes in payment models,” Congressman Scott said in a prepared statement. “This delay will ensure that both doctors, hospitals and post-acute care facilities are able to implement these changes without harming or reducing patient care.”

The bill is a last-ditch effort to delay the new payment model. Last fall, 59 members of Congress sent a letter to CMS administrators voicing their concerns over the fast-tracked payment changes in the bundled model. The bill was referred to the House Ways and Means Committee, but is unlikely to be read before the CJR models are set to start on April 1, 2016.

Written by Amy Baxter

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