Hos­pi­tals urge Trump ad­min­is­tra­tion to end manda­tory bun­dled-pay plans

Modern Healthcare - - NEWS - By Vir­gil Dick­son

Sev­eral hos­pi­tals and hos­pi­tal groups say they don’t have the money to im­ple­ment Obama-era bun­dled-pay­ment ini­tia­tives for car­diac and or­tho­pe­dic care and hope the Trump ad­min­is­tra­tion makes them vol­un­tary pro­grams.

The CMS last month de­layed the ef­fec­tive dates of four new pay­ment mod­els from July 1 un­til Oct. 1, 2017, and sought com­ments on whether they should be de­layed even fur­ther un­til Jan. 1, 2018.

Since then, hos­pi­tals around the coun­try have sub­mit­ted com­ments ask­ing the CMS to turn bun­dled pay­ments into vol­un­tary ini­tia­tives be­cause they can’t af­ford the care-man­age­ment services and health in­for­ma­tion tech­nol­ogy the mod­els re­quire. The bun­dled-pay­ment ini­tia­tive would crip­ple safety net hos­pi­tals that rely mostly on the Medi­care, Med­i­caid and dis­pro­por­tion­ate-share hos­pi­tal pay­ments, ac­cord­ing to the Greater New York Hos­pi­tal As­so­ci­a­tion.

The Cal­i­for­nia Hos­pi­tal As­so­ci­a­tion, among other state groups, has the same con­cern. The Mis­souri Hos­pi­tal As­so­ci­a­tion asked the CMS to can­cel any manda­tory pay mod­els out­right.

“It treats the na­tion’s hos­pi­tals as lab rats in the ex­per­i­men­ta­tion, with hos­pi­tals ran­domly as­signed to im­ple­ment com­po­nents of a grow­ing num­ber of com­plex CMS ini­tia­tives,” the MHA said in a com­ment let­ter.

But Penn­syl­va­nia-based Geisinger Health Sys­tem said al­low­ing hos­pi­tals to opt into the pro­grams could lead to some gam­ing the sys­tem by se­lec­tively re­fer­ring or trans­fer­ring com­plex pa­tients to providers not par­tic­i­pat­ing in the model.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion said it sup­ported the mod­els’ over­all

One of the mod­els would make hos­pi­tals in 98 mar­kets fi­nan­cially ac­count­able for the cost and qual­ity of all care associated with by­pass surgery and heart at­tacks.

goal to make providers more ac­count­able for co­or­di­nat­ing pa­tients’ care. It has, how­ever, voiced con­cerns over the roll­out of the mod­els. The AHA sup­ports de­lay­ing im­ple­men­ta­tion un­til Jan. 1, 2018.

Any fur­ther de­lays “would ef­fec­tively turn the start date for these pro­grams into a mov­ing tar­get—hos­pi­tals and health sys­tems would con­tinue to ex­pend re­sources to prepare for some­thing that we fear would never come to fruition,” the AHA said in a com­ment let­ter.

The CMS de­cided to de­lay the pro­grams while it eval­u­ated them. The agency said it needed time to un­der­take no­tice and com­ment rule­mak­ing and im­ple­ment any nec­es­sary changes.

The agency first in­tro­duced the bun­dled-pay­ment mod­els in July, and the rule­mak­ing was fi­nal­ized in De­cem­ber. One of the mod­els would make hos­pi­tals in 98 mar­kets fi­nan­cially ac­count­able for the cost and qual­ity of all care associated with by­pass surgery and heart at­tacks.

The rule also ex­panded the CMS’ first manda­tory bun­dled-pay­ment model— which be­gan in Jan­uary in 67 mar­kets and cov­ers to­tal hip and knee re­place­ments—to in­clude surg­eries re­pair­ing hip and fe­mur frac­tures.

The pay­ment mod­els aimed to shift the in­dus­try away from a fee-for-ser­vice Medi­care pro­gram. HHS Sec­re­tary Tom Price has ve­he­mently op­posed the CMS’ manda­tory ini­tia­tives. While in Congress, Price was one of 179 law­mak­ers who called on the CMS to “cease all cur­rent and fu­ture planned manda­tory ini­tia­tives un­der the Cen­ter for Medi­care & Med­i­caid In­no­va­tion, in­clud­ing bun­dled-pay­ment mod­els.”

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