Dr. Price Brakes Bundled Payments Expansion

Our orthopedic surgeon and Health and Human Services Secretary, Tom Price, M.D., has said he is no fan of mandatory bundled payments.

After just taking office in February, he’s already putting on the brakes to the payment model with the March 20, 2017 announcement that the expansion of hip and knee replacement bundled payment programs (Comprehensive Care for Joint Replacement – CJR) from the Centers for Medicare and Medicaid Services’ (CMS) Innovation Center will be delayed.

Last fall, then Congressman Price, said in a letter to the Obama administration that CMS had overstepped its authority, upsetting the balance between the executive and legislative branches and failing to engage stakeholders when creating the programs. He also wrote, “these mandatory models overhaul major payment systems, commandeer clinical decisionmaking and dramatically alter the delivery of care.”

According to a March 20 notice in the Federal Register, the CJR program was scheduled to expand on the 20th, but those expansions will now be delayed until May 20, 2017 to “allow time for additional review, to ensure that the agency has adequate time to undertake notice and comment [on] rulemaking to modify the policy if policy modifications are warranted,” and to make sure its participants understand the rules and how to comply with them.

The expansions were supposed to take place on January 21, 2017, but President Trump ordered a 60-day regulatory freeze when he took office. At the time, Modern Healthcare reported that an HHS spokesman confirmed that the executive order would not slow the launch of the initiative. The spokesperson also reportedly said the delay should not impact day-to-day operations of providers working under the bundled-payment models.

The agency is also asking for comment about potentially delaying the expansion of the joint replacement program, until January 1, 2018.

The announcement raises questions about the Obama-era move from fee-for-service payment models to pay-for-performance value-based models. The original goal of the move to value payments was to have half of traditional Medicare dollars go through alternative payment models by 2018.

The Federal Register notice added that the delay would give participants more time to prepare for these models and that it would be preferable for payment periods to align with the calendar year.

The CJR program was rolled out in April 2016 across 800 hospitals in 67 metropolitan areas. Medicare pays providers a single amount to cover all the costs associated with a hip or knee replacement over a 90-day period. The program was slated to expand in July to include repairing hip and femur fractures as well as cardiac care.

Submitting Comments

Comments must be received no later than 5 p.m., 30 days after March 21, 2017. Please refer to file code CMS 5519-IFC.

You may submit comments in one of four ways:

1. Electronic comments to http://www.regulations.gov. Follow the “Submit a comment” instructions.

2. Mail written comments to:Centers for Medicare & Medicaid Services
   Department of Health and Human Services
   Attention: CMS-5519-IFC
   P.O. Box 8013, Baltimore, MD 21244-8013

3. Express or overnight mail to the following address ONLY:Centers for Medicare & Medicaid Services
   Department of Health and Human Services
   Attention: CMS-5519-IFC
   Mail Stop C4-26-05
   7500 Security Boulevard
   Baltimore, MD 21244-1850

4. Hand or courier delivered ONLY in Washington, DC, to:CMS-5519-IFC
   Centers for Medicare & Medicaid Services
   Department of Health and Human Services
   Room 445-=G, Hubert H. Humphrey Building
   200 Independence Avenue
   SW.,Washington, DC 20201