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  • Expanded CMS Bundling Programs – With Payment Incentives – Ready to Launch in 2017

    Amid administrative changeover and potential shifts in the future, the Centers for Medicare and Medicaid (CMS) is moving ahead to expand its mandatory bundled payment programs related to cardiac care and joint replacement. And there's good news for physical therapists (PTs): the new rule will make it possible for PTs to receive incentive bonus payments for joint replacement care provided in 2017 as part of a bundled care program.

    Under an updated Comprehensive Care for Joint Replacement (CJR) program beginning on January 1, 2017, clinicians, including PTs, will receive additional opportunities to qualify for a 5% payment bump through the Advanced Alternative Payment Model (APM) path. Clinicians using the new accountable care organization "Track 1+ Model"—a program with a slightly more limited downside risk, designed for smaller practices—could earn the bonuses for care delivered in 2018. The new avenues to incentives were opened up when CMS decided to include the bundling models in its list of qualified APMs.

    The CJR debuted April 1, 2016, and was the first time CMS implemented a mandatory bundling program, albeit one limited to 67 metropolitan statistical areas. The basic idea: CMS establishes a lump payment target for total episode of knee and hip replacements, from admission to 90 days postdischarge, and compares what hospitals spend in total on care with what Medicare thinks they should be spending. If the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare—but if they spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference.

    In addition to the increased opportunities for payment incentives, the 2017 version of the CJR will expand bundling provisions beyond hip and knee arthroplasty to include patients undergoing care for hip and femur fractures. That project is set to launch in July 2017 and will last for 5 years.

    CMS will also move ahead with a similar program focused on cardiac care in 98 randomly selected metropolitan areas (which happen to include the 67 areas already covered in the CJR). The cardiac model will be applied to care associated with bypass surgery and heart attacks, and includes provisions that will incentivize the use of cardiac rehabilitation. Like the CJR, participating clinicians will be eligible for incentive payments, but not until the 2018 performance year at the earliest. The program will begin on July 1, 2017, and continue until December 31, 2021.

    Well, maybe it will. According to some media reports, members of the incoming Trump administration—particularly Rep Tom Price, its nominee for Health and Human Services Secretary—aren't particular fans of the ways in which the Centers for Medicare and Medicaid Innovation (CMMI) has mandated the programs. National Public Radio reported that in September, Price was among a group of GOP lawmakers who wrote to CMS urging that CMMI "stop experimenting with Americans' health, and cease all current and future planned mandatory initiatives."

    "Obviously, whenever administrations change over, even when control stays with the same party, you can expect change," said Roshunda Drummond-Dye, APTA director of regulatory affairs. "We will leave the predictions about what will happen to the bundling programs to others, and instead focus our efforts on helping our members understand how to work most effectively within these models. Right now, we're very pleased that CMS listened to our comments and will be including CJR and other bundled payment models in the list of advanced alternative payment models under [the Medicare Access and CHIP Reauthorization Act, or MACRA], which allows PTs to participate in payment incentive programs."

    The association's education efforts on bundling began well before the April 1 startup of CJR, and include 2 webinars (1 on the basics of the CJR program, and 1 that includes insights from PTs participating in bundled care programs), an article in PT in Motion magazine, and an entire webpage that contains background information as well as links to evidence-based clinical information and community programs.

    APTA regulatory affairs staff will review the final rule on the bundling programs and post a summary in the coming weeks.

    Comments

    • Does CMS plan to expand the current CJR program beyond the original metro areas this year?

      Posted by david quint on 12/21/2016 4:25 PM

    • Thanks for the question, David. The answer is no. Based on current rulemaking for 2017, CJR is not expanding past the current MSAs. But don't forget about the 98 MSAs that will be mandated to participate in the cardiac care bundle payment models.

      Posted by APTA Staff on 12/22/2016 8:03 AM

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