Com­ments on Medi­care’s bun­dled pay­ment test due Sept. 8

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dick­son

Com­ments are due this week on Medi­care’s first manda­tory bun­dled pay­ment test, cov­er­ing hip and knee re­place­ments.

The model would be­gin Jan. 1 and run for five years in 75 mar­kets. Episodes in­cluded in the bun­dle would be­gin with ad­mis­sion to the hos­pi­tal and end 90 days af­ter dis­charge.

The hos­pi­tal would bear fi­nan­cial risk for the pro­ce­dure, the in­pa­tient stay and all care re­lated to the pa­tient’s re­cov­ery.

The pro­gram is pro­jected to save Medi­care a to­tal of $153 mil­lion.

One con­cern raised in com­ments so far ques­tions the model’s ex­clu­sion of some safety net ru­ral providers in ar­eas with fewer than 50,000 peo­ple.

“With­out those providers, your model will not ad­e­quately ad­dress ... vari­a­tions in size, profit sta­tus, and episode uti­liza­tion pat­terns, and ex­am­ine whether these char­ac­ter­is­tics im­pact the ef­fect of the model on pa­tient out­comes and Medi­care ex­pen­di­tures,” Keith Bridges, a vice pres­i­dent at Ken­tucky-based Ephraim McDow­ell Health Care Foun­da­tion, said in a com­ment let­ter.

The CMS ex­plained the de­ci­sion by say­ing that ru­ral providers, of­ten the only source of healthcare ser­vices in those ar­eas, may have lim­ited op­tions for co­or­di­nat­ing care and re­duc­ing costs while main­tain­ing qual­ity.

Hip and knee re­place­ment surg­eries, which are among the most com­mon pro­ce­dures that Medi­care ben­e­fi­cia­ries re­ceive, can range in re­im­burse­ment from $16,500 to $33,000, ac­cord­ing to the CMS.

In 2014, ap­prox­i­mately 430,000 ben­e­fi­cia­ries were dis­charged fol­low­ing lower-ex­trem­ity joint re­place­ments, cost­ing Medi­care more than $7 bil­lion for the hos­pi­tal­iza­tions alone.

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