Sensing a chance to weaken or outright eliminate a proposed rule change that has long made them leery, hospital trade associations are lining up to pressure the federal government on mandatory bundled payment programs.
The Centers for Medicare and Medicaid Services (CMS) announced a delay on the launch of several new bundled payment programs covering cardiac care and orthopedic procedures, previously set to begin on July 1st. That would put the start date in October, though the agency hinted the rule change could be pushed all the way to 2018 if public comment supported an even longer lead time before implementation.
It was one of the clearest signs yet that the members of President Donald Trump’s administration are invested in using the mechanics of government to disassemble key cost control measures that grew out of the Affordable Care Act.
Tom Price, the Trump administration’s Secretary of Health and Human Services, has publicly condemned the revised payment models, further emboldening the new opposition efforts. As recently as September of last year, Price joined a fleet of fellow GOP lawmakers in submitting a letter to the CMS that complained the changes “overhaul major payment systems, commandeer clinical decision-making, and dramatically alter the delivery of care.”
Hospital associations in New York, California, and Missouri have all fired off letters to the CMS since the implementation delay was announced.
“Medicare and Medicaid rates no longer cover an adequate level of operating and capital costs, and the resulting lack of margins for safety net hospitals does not allow for capital investment,” the Greater New York Hospital Association wrote, according to a report in Modern Healthcare.
The American Hospital Association (AHA) has also entered into the fray, although their concerns are more tempered. The group expresses openness to the new reimbursement structure.
“Our members support the health care system moving toward the provision of more accountable, coordinated care and are in the process of redesigning delivery systems to increase value and better serve patients,” the organization writes. “As such, the AHA agrees with the principles underlying the cardiac and surgical hip and femur fracture treatment (SHFFT) bundled payment models and believe they could help further these efforts to transform care delivery through improved care coordination and financial accountability.”
The AHA expresses support for the delayed implementation of the mandatory bundled payment models, but cautions that further dickering “would effectively turn the start date for these programs into a moving target.”
The letter from the ACA specifically notes that repeated delays of the introduction of the mandatory bundled payments model will only exacerbate the frustrating uncertainty that has dogged the healthcare industry since the election of Trump, whose campaign rhetoric about repealing the Affordable Care Act hasn’t yet translated into legislative action. Additional calendar shifts would force healthcare providers to “continue to expend resources to prepare for something that [they] fear would never come to fruition,” the ACA writes.
Advocates for bundle payments cite research that suggests the model saves money for consumers, healthcare facilities, and providers of insurance coverage. One recent study determined that universal adoption of the model could result in yearly savings of $2 billion for Medicare.
