By: Dexter Braff
In what we can only describe as a Scooby Doo-like, head-cocked-to-the-side, “say what” of the highest order, last September, Tom Price and 178 House Members sent a letter to Andy Slavitt, then acting CMS Administrator, and Patrick Conway, MD, Deputy Administrator for Innovation and Quality, demanding that new payment models (chief among them, bundled payment initiatives) developed by the Centers for Medicare and Medicaid Innovation, be terminated immediately.
In the letter, the authors explained that by mandating the adoption of new payment programs, “CMMI has exceeded its authority, failed to engage stakeholders, and has upset the balance of power between the legislative and executive branches.”
Now, admittedly, we are not constitutional scholars. But it would seem to us that ever since Medicare was created in 1965, administrators have been churning out rules faster than Steven King churns out novels. Plus, theirs are scarier.
What’s more, ever since the new face of health care has been brought to you by the letters “A,” “C,” and “O,” hasn’t the goal of shifting 50% of Medicare payments to “alternative payment models” by 2019 become health care’s version of the Moon Shot?
And hasn’t the bundled payment model been, kinda, sorta, universally accepted as the simplest – yet no less transformational – move from dis-integrated, fee-for-service to coordinated, multi-disciplinary, fee-for-outcome?
Oh, and hasn’t there been a study that reports that under Medicare’s mandatory Comprehensive Care for Joint Replacement bundled payment model,“between July 2008 and June 2015, average Medicare episode expenditures declined 20.8%, from $26,785 to $21,208 for 3,738 episodes of joint replacement without complications”? And that, “readmissions and emergency department visits declined 1.4% and 0.9%, respectively, while episodes with prolonged length of stay decreased 67.0%”
[1]?
And one more thing:
Health care mergers and acquisition strategies are in the midst of a 180 based upon these and other developments that positively scream – choose your metaphor – that the train has left the station, the horse has left the barn, the ship has sailed on the adoption of episodic payment initiatives such as bundling, and its not-so-distant-cousin, population health management, as the future of health care.
Despite (or because of) Price’s reticence, on May 19th, CMS issued a final rule that delays the expansion of the Comprehensive Care for Joint Replacement (CJR) Model, the Cardiac Rehabilitation Incentive Payment Model and the care coordination models until Jan. 1, 2018.
It remains to be seen how this all plays out.
However, according to a recent article that appeared in Healthcare Finance,
“providers and especially payers will accelerate towards these alternative payment models…Payers need more predictability in cost, and bundles provide a tangible way to get there, according to Carolyn Magill, CEO of Remedy Partners, a firm that provides services to close to 70 percent of participants in CMS’ Bundled Payment for Care Improvement initiative. ‘There’s been an increasing adoption and curiosity,’ Magill said. ‘Three or four years ago, it was more about curiosity. Now the traction is happening.’”[2]
In an industry where it’s hard to even reach consensus on whether it’s “payer” or “payor” (it’s clearly ‘payor,’ as in you get paid, or you don’t), it’s rare to see this kind of convergence of thought across a broad base of constituents from regulators, to providers, payors – even Wall Street.
So, if Secretary Price can’t get as far as embracing these initiatives as a Bundle of Joy, perhaps, at the very least, he can take comfort in knowing that to many, they’re not a bundle of Oy!