The CFA Perspective

Breaking News:  Another Signal of the End of the Cardiac Bundled Pricing Initiative Era

Posted by Charles Franc

9/20/17 1:19 PM

Another Signal of the End of the Cardiac Bundled Pricing Initiative Era.jpgIn an article published in The Wall Street Journal on Tuesday, Sept. 19, by Seema Verna, the administrator of Centers for Medicare & Medicaid Services (CMS), stated the Trump Administration is planning to move the CMS Innovation Center in a direction to give providers more flexibility with new payment models and to increase healthcare competition.  Verma stated CMS is reviewing all Innovation Center models “to determine what is working and should continue, and what isn’t and shouldn’t.”

A key statement Verna made in the article is, “The complexity of many of the current models might have encouraged consolidation within the healthcare system, leading to fewer choices for patients. Strengthening Medicare and Medicaid will require health-care providers to compete for patients in a free and dynamic market, creating incentives to increase quality and reduce costs.”  Verma stated, “On Wednesday, we are issuing a ‘request for information’ to collect ideas on the path forward. We will move away from the assumption that Washington can engineer a more efficient healthcare system from afar—that we should specify the processes healthcare provider are required to follow.”

On the following day, Sept. 20, CMS published Centers for Medicare & Medicaid Services: Innovation Center New Direction.  In the background statement, CMS states, “One of the most important goals at CMS is fostering an affordable, accessible healthcare system that puts patients first. Through this informal Request for Information (RFI) the CMS Innovation Center (Innovation Center) is seeking your feedback on a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. The Innovation Center welcomes stakeholder input on the ideas included here, on additional ideas and concepts, and on the future direction of the Innovation Center.”

In addition to the Request for Information (found here) seeking input from key healthcare stakeholders, CMS listed the eight areas of focus for new payment models they are interested in:

  1. Increased participation in Advanced Alternative Payment Models (APMs);
  2. Consumer-Directed Care & Market-Based Innovation Models;
  3. Physician Specialty Models;
  4. Prescription Drug Models;
  5. Medicare Advantage (MA) Innovation Models;
  6. State-Based and Local Innovation, including Medicaid-focused Models;
  7. Mental and Behavioral Health Models; and
  8. Program Integrity.

CFA encourages healthcare managers throughout the country to read and consider the CMS statement (link above) and the RFI request document by CMS.  This is a unique opportunity to provide experienced and practical input into the decision-making process of CMS for the future of payment models affecting nearly every provider.  The deadline for submitting comments and ideas is 11:59 PM EST, November 20, 2017.

As always, CFA invites your comments, suggestions and questions.  Please contact CFA at (949) 443-4005 or by e-mail at cfa@charlesfrancassociates.com.

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