Providers are pleading with the CMS to slow its flood of new payment models in the effort to move from fee-for-service to value-based care.
Since the start of the year, the agency has introduced or expanded nine pay models and announced selected markets for another three. In comments on a July proposed rule that would make 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks, industry stakeholders ask the agency to step on the brakes.
Last year, HHS announced the goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as accountable care organizations or bundled-payment arrangements by the end of 2016, a goal it hit by March. Its next target ties 50% of payments to these models by the end of 2018.
Hospitals “have become increasingly concerned about the pace of change proposed by the CMS and the unreasonable expectations and burden that such rapid and multiple changes in the delivery system and related payment structure place on hospitals and their work forces,” the Federation of American Hospitals said in a comment. “Simply put, this is too fast and too soon.”
The trade group said it believes that the CMS first needs to evaluate and learn from hospitals' Comprehensive Care for Joint Replacement Model, or CJR experience, which is less than 6 months old, and from the results of the Bundled Payments for Care Improvement initiative.
Others agreed. “In failing to take the time to learn from CJR, the agency has missed a critical opportunity to move bundled-payment models forward in a meaningful way,” the AHA said in a comment. “This proposed rule raises serious concerns about the agency's pace of change, as well as its ability to accurately track and process the outcomes of its myriad, increasingly complex alternative payment models.”
The trade group also pushed back against the CMS' proposal to expand the CJR program to include surgical hip and femur fracture treatment episodes, or to require certain CJR hospitals to also implement the cardiac bundled-payment model, especially considering neither the CMS nor hospital participants have had the time or the data to be able to analyze any lessons learned from the model as it is.
“Hospitals do not have an unlimited capacity to implement bundled-payment models,” AHA said.
The CMS received 178 comments on the cardiac model proposed rule by its Oct. 3 deadline.
