If you think the Bundled Payment Care Improvement(BPCI) initiative is a thing of the past, think again. Even though the Centers for Medicare and Medicaid Services (CMS) issued a final rule cancelling the episode payment models, that method of reimbursement is embedded in the healthcare system.
That’s the strong opinion of a panel of industry players we assembled for our webinar, “Bundled Payments: The Changing Outlook on Post-Acute Care,” on November 30, 2017, the same day that CMS made the announcement. Here’s what Chris Garcia, CEO of Remedy Partners, and Eugene Goldenberg, VP at Cain Brothers, and Rich Tinsley, CEO of Stoneridge Partners, had to say.
Garcia had just visited Seema Varma, head of CMS, the day before the announcement that bundled payment models, including those for hip fracture and cardiac treatment, were now voluntary, not mandatory. The agency also scaled back the number of geographic areas participating in the comprehensive care for joint replacement model.
Both rule changes were expected, and Varma said the agency anticipated announcing new voluntary payment bundles “soon.”
“The BPCI program is going to be renewed and expanded,” Garcia told the webinar attendees. “I don’t think there’s any question that the government’s bundled payment program, BPCI Models 2 and 3, are going to continue in another program. The only question that remains is when are they going to make that announcement.
“In order to publish the new rule for BPCI Advanced, [CMS] had to discontinue the mandatory cardiac program and hip fracture programs, and that seemed to be standing in the way of the new release,” he added. “This announcement obviously clears the part towards a bundled payment announcement. We expect that imminently.”
Eugene Goldenberg agreed on the CMS’ direction, but differed on the timeline. “The pace at which we’re going to get there may be a bit different. There seems to be a few more hurdles in the way, now.”
While most of the attention was focused on the BPCI announcement, Goldenberg pointed out that CMS had also expanded the Medicare Advantage-based care pilot by expanding it to 15 more states through 2019.
“There’s been some mixed messaging to the marketplace [from CMS], as if there wasn’t enough confusion here yet,” he added. “I think we’re still on the same path. The question is just how quickly we’re going to get to the same goal.”
That creates more uncertainty for the marketplace, said Rich Tinsely. “The pace question, because it’s so open-ended, creates issues for the marketplace about how fact they’re going to be able to move. The more certainty the administration can provide going forward, the better off we are.”
Commercial payors are taking the lead, and bundled payments will become the norm, Garcia posited. “Commercial payors are very quick to adapt. They’re now seeing the spoils, if you will, from the bundled payment initiative that the government started.”
His company is being inundated with calls from payors and providers who want to approach commercial payors with proposals for bundled payments to cover their member populations.
“As you might imagine, all the big players, everybody is talking about it and experimenting, trying to figure that out,” he said. “Bundled payments could actually see a much more rapid adoption in the commercial insurance space than what we’re seeing in the government space.”
Like that’s never happened before. Brace yourself for the new reimbursement reality.
