The CMS' decision to delay expansion of a major, mandatory bundled-payment pilot, the Comprehensive Care for Joint Replacement Model, raises questions about the future of such initiatives under the Trump administration. These value-based efforts were a hallmark of healthcare reform under the Obama administration, which set the goal of having half of traditional Medicare dollars go through alternative payment models by 2018.
HHS Secretary Tom Price has staunchly opposed the CMS' mandatory initiatives. The CMS is weighing pushing back the implementation of all mandatory bundled-payment initiatives even further, until 2018. The delays could ultimately presage a decision by the CMS to make them voluntary, several experts said.
But, if participating in these alternative payment models is no longer mandatory, “you're going to have a huge selection problem,” said Dr. Ashish Jha, a professor of health policy at the Harvard School of Public Health. Only providers that believe they can succeed under such models will participate, ultimately driving up costs, he added.