News & Events


What Will Follow Pullback From Mandatory Bundles?

By: RICH DALY, HFMA SENIOR WRITER/EDITOR

DATE: December 1, 2017

SOURCE: http://www.hfma.org/Content.aspx?id=57173

DataGen was recently featured in an article from hfma.org.

PROPOSED RULES OUTLINING A SUCCESSOR TO THE POPULAR BPCI PROGRAM ARE EXPECTED VERY SOON, ACCORDING TO INDUSTRY ADVISERS.

Medicare recently issued a final rule that drastically scaled back its use of mandatory bundled payments. Now providers are preparing for a new round of voluntary, hospital-led bundles.

The Centers for Medicare & Medicaid Services (CMS) followed through on an August proposal to cancel mandatory bundled payment programs for cardiac care and surgical hip and femur fracture treatment (collectively known as episode payment models [EPMs]). The agency also canceled the cardiac rehabilitation (CR) incentive payment model.

The mandatory models were scheduled to start Jan. 1, 2018.

Nearly two years into the Comprehensive Care for Joint Replacement (CJR) model, CMS also finalized plans to switch participation from mandatory to voluntary for hospitals in 33 of the 67 selected geographic areas. Hospitals in 34 high-cost areas still must participate unless they meet CMS designations as “rural” or “low-volume.”

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