CMS Backtracks Value-Based Care Models

Although the Trump administration claims it’s not actively moving away from the goals of value-based care—and attests that it supports alternatives to fee-for-service—recent rulemaking suggests a change in emphasis.

A final rule released by the Centers for Medicare and Medicaid Services (CMS) on November 30 officially canceled both the Episode Payment Model and the Cardiac Rehabilitation Incentive Payment Model, which were scheduled to take effect on Jan. 1, 2018, according to the Federal Register. Additionally, CMS scaled back its Comprehensive Care for Joint Replacement (CJR) Model to include only 34 geographic regions from the originally planned 67 geographic regions. This change leaves 470 participating hospitals, including 60 to 80 hospitals that are doing so voluntarily.

The change to the CJR model alone will reduce Medicare’s savings from $295 million over three years to $189 million. The cardiac care models were expected to save Medicare $170 million collectively over five years.

When these changes were first proposed, CMS said that it had considered making participation in the bundled payment models voluntary since so many hospitals and providers have long been investing in the personnel and IT systems necessary to comply. However, it opted not to do so because it did not believe that such alterations would offer providers enough time to prepare for the changes, Modern Healthcare reported. As they reported at the time, according to the Association of American Medical Colleges, hospitals can pay care coordinators up to $81,000 a year and as much as $1 million on vendor products that track eligible patients.

In a webinar sponsored by the Center for Health Journalism this week, former CMS chief data officer Niall Brennan said he expects to see healthcare costs rise in 2018 due in part to the rollback of measures like this.

“We take seriously the commenters’ concerns about the urgency of continuing our movement toward value-based care in order to accommodate an aging population with increasing levels of chronic conditions,” CMS said in the final rule.

Click here to read the Final Rule.

Mary Butler is the associate editor at The Journal of AHIMA.

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