CMMI seeks feedback on pay bundles for post-acute care

The top deputy for the Center for Medicare and Medicaid Innovation told hospital leaders on Monday he is eying a bundled payment model for post-acute care.

Innovation Center Director Adam Boehler told the audience at the American Hospital Association's annual meeting that he's seeing a flood of interest from industry, and he called for ideas on how a new approach could save money while improving care.

"We've heard a lot of comment there, and I think we are interested in the concept of acute-care bundles," Boehler said. "Now is the time to raise ideas there."

After the speech, the CMMI director declined to give a timeline for a prospective model other than there's nothing coming imminently. For now the the agency is in "listen mode," he added.

"Post-acute care is an area where we can improve quality and save money," he said. "From that perspective we like it. The devil's in the details on how to set up the models correctly."

This expensive segment of the healthcare industry has been drawing investment both from private equity firms and big hospital systems as they buy up nursing homes.

Hospitals are increasingly reluctant to release patients to skilled-nursing facilities if they can send them home, citing quality reporting issues. This is supported by an October report from Welltower that said the post-acute provider world will shrink in the face of changing regulations and a shift to new payment systems.

And, as evidenced by ProMedica's $1.4 billion acquisition of the bankrupt nursing home operator HCR ManorCare last year, health systems have the infrastructure and financial position to invest in a population poised to grow as baby boomers age. The number of 80- to 85-year-olds is slated to grow at about 5% per year over the next decade, and to more than double within the next 20 years.

On the rural healthcare front, Boehler is also mulling new payment ideas as momentum continues to try to avert more hospital closures. In Monday's speech he echoed last year's discussions on Capitol Hill about global payment models as a way to give those hospitals time and space to figure out how they can reconfigure their operations.

"We're thinking about the opportunity to say, 'Hey, let's give people the cover of night for a little bit, let's kind of freeze things for a while,' " Boehler said.

He gave the example of a hospital reducing its number of inpatient beds while expanding its ambulatory clinics and telemedicine offerings, as well as incorporating more behavioral health into its treatment.