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.
