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.
Hospital groups say they don't have the financial resources to implement bundled payment models.
The American Hospital Association said it supported the models' overall 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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