CMS Pushes Back Cardio, Ortho Bundled-Pay Models
Trump's new CMS Chief Seema Verma has only been in place for a week, but an agency decision to delay implementation of two bundled-payment initiatives – one on cardiac care and one on joint replacements – underscores the administration's wariness of mandatory value-based payment models.
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The shift in health care reimbursement from a fee-for-service model to one which is based on value and an emphasis on accountability for care quality and health care costs is here to stay. In orthopedics, as in other therapy sectors, physicians are having to grapple with new alternative payment models and meeting the requirements that come with these new reimbursement methods. Strategies for adopting these value-based systems, including challenges and trends, and what it all means for surgeons, dominated much of the discussion at this year's American Academy of Orthopaedic Surgeons (AAOS) annual meeting in San Diego.
The Senate confirmed former health-policy consultant Seema Verma as administrator of the US Centers for Medicare and Medicaid Services earlier this month, and she was sworn in March 14. Medtech Insight took a look at some of Verma's policy positions affecting industry, including potential changes to accountable care organizations, appropriate-use criteria, the Centers for Medicare and Medicaid Innovation, lab payments, and telehealth services.
The US Center for Medicare and Medicaid Services finalized three new bundled payment models for cardiac care and one for hip surgeries that will prompt hospitals to adopt them by providing clinicians up to 5% more for Medicare reimbursements. The cardiac and joint care models look similar to last year's "Comprehensive Care for Joint Replacement" plan, in that they still permit inpatient new technology add-on payments and outpatient transitional pass-through payments for device use by excluding those costs from episode payment model calculations.