Release of bundled-payment rules to quicken

Regulators will accelerate release of rules implementing bundled payments under the Patient Protection and Affordable Care Act, according to a senior official at the CMS.

Dr. Richard Gilfillan, acting director of the new Center for Medicare and Medicaid Innovation at the CMS, said at a Monday policy discussion at a liberal Washington think tank that the rules implementing bundled payments for Medicare providers will come before their 2013 deadline. In addition, he expects bundled payments to initially focus on the acute- and post-acute-care segments because private-sector initiatives have already succeeded in those areas.

“There’s lots of priorities and to date there’s not that much to join up with in the private sector on chronic-care bundles, so we think right now our first step ought to be on the other front, and we’re not putting it to the side for very long,” Gilfillan said about bundle payments for chronic-disease management.

Advocates of bundled payments for episodes of care have touted their potential to reduce the growth in healthcare costs, which are dramatically greater among patients requiring care for multiple chronic diseases than among acute- and post-acute-care patients.

Gilfillan indicated that the bundled-payment rules will likely rely on a retrospective approach because much less is known about prospective bundled payments.

The rules also will encourage bundled payment programs to “start small initially but be built for scaling.”

Providers will likely favor bundled payments more than the controversial accountable care organizations proposed earlier this year because they will allow providers to increase profitability for specific patients, even as overall spending is more limited, he said.