The Trump administration has not been bashful about its desire to scale back several initiatives launched under its predecessor. Perhaps the most significant actions have been steps to reverse course on mandating that providers participate in various alternative-payment programs.
Beyond loosening requirements for physicians to contend with the Medicare Access and CHIP Reauthorization Act, CMS officials are looking to free hospitals and doctors from bundled-payment initiatives. The agency in August proposed canceling mandatory bundled-payment initiatives for heart attacks, bypass surgeries and hip and femur fractures that were set to begin in January. Industry groups will be busy this week putting the final touches on comments to the agency, which are due Oct. 16.
Beyond proposing to cancel the bundle programs, the agency wants to curtail from 67 to 34 the mandatory geographic areas participating in the Comprehensive Care for Joint Replacement, or CJR, model.
"Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries," CMS Administrator Seema Verma said when the proposed rule was released in August.
While industry groups have generally opposed the mandatory nature of these programs, there wasn't unanimous support for axing them entirely when the proposed rule was issued. The American Hospital Association wondered what that would mean for members that have already dedicated resources to building out programs to support the bundles.
But the trade group representing safety net hospitals was more supportive.
"This cancellation gives CMS an opportunity to evaluate current models and correct for unintended consequences before developing another voluntary or mandatory demonstration," Dr. Bruce Siegel, CEO of America's Essential Hospitals, stated in August.