CMS cancels two mandatory pay models and scales back a third

The CMS on Tuesday said it will toss two bundled payment models and cut down the number of providers required to participate in a third, citing providers’ requests to have more input in the models’ designs.

The agency slashed the number of mandatory geographic areas participating in the Comprehensive Care for Joint Replacement (CJR) model from 67 to 34, it announced in a proposed rulemaking Tuesday.

The agency is also proposing to exclude low-volume hospitals, or those with fewer than 20 CJR episodes over three years, in the remaining mandatory areas starting in February 2018. However, the CMS will allow the newly excluded providers to voluntarily participate in the model if they so choose. Rural hospitals in the remaining mandatory markets also have the choice to participate.

The CMS’ proposed rule also plans to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin on Jan. 1, 2018. Eliminating these models would give the CMS greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute-care spectrum.

“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 in a statement.

Moving forward, the CMS expects to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory episode payment model efforts. The changes in the proposed rule would allow the agency to engage providers in future voluntary efforts, including additional voluntary episode-based payment models.

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