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In the News: CMS Delays Bundled Payments – What it Means for Your Organization

In April of 2016, The Centers for Medicare and Medicaid Services (CMS) mandated bundled payments as a part of the Comprehensive Care for Joint Replacement (CJR) model, which holds hospitals financially accountable for the quality and cost of a CJR episode.

Amid the uncertainty with the future of ACA, CMS has delayed the expansion of CJR to include hip and femur fractures by three months. The expansion was set to go live on July 1, and will now take place on October 1, 2017.

The final interim ruling, posted to the Federal Register on Monday, March 20, also delays mandatory bundled payments for cardiac care (Cardiac Rehabilitation Incentive Payment Model), including heart attacks and bypass surgeries to the same dates listed above, but is likely to be pushed back to Jan. 1, 2018.

In its ruling, CMS cites that additional time is needed for review, “to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps due to the rule taking effect for a short duration before any potential modifications are effectuated.”

Our Take
A little bit of breathing room in order to get it right is ok. It also gives procrastinators a little bit more time to get on board and embrace the opportunity to be transparent.

The delays don’t take away the importance of being prepared for the incoming changes. Bundled payments and data collection programs take time to put in place, so if you get started now before the mandates inevitably take place, you’ll stay ahead of the curve in this increasingly competitive space.

That’s the attitude that NorthBay Healthcare in Solano, California is taking. CODE recently spoke with Cynthia Giaquinto, Program Manager for Orthopedics. She said of the postponement, “We’re not going to let this delay our momentum. We’re going to be ready.”

“We’re pretty sure that CMS is going to continue forward with this process. We are always proactive. We don’t let things sneak up and smack us in the face. We’re ready to go when things happen.”

Even if you’re not proactive with bundled payments, CMS still assigns Composite Quality Scores – nothing has changed there. With Composite Quality Scores, the more points you have, the better grade you’ll receive. That being said, the voluntary collection of PROs gives you two extra points towards your total score. As you can see from CODE’s Guide to CJR, these two points could mean the difference between an “acceptable” composite rank and a “good” which is enough to turn a $17K deficit into a $31K surplus.

Get ahead of the curve. Despite the delay with bundled payments, collecting patient-reported outcome (PRO) data still has many value propositions to hospitals, private practices and their patients. It’s time to embrace the opportunity to be transparent, understand costs and outcomes, and how they work together.

How CODE Technology Can Help

  • CODE offers a turnkey solution for PRO collection. We’re up and running in 30 days with an average capture rate of 90% across all intervals of collection. (CJR requires 50%) To get that capture rate even higher, patients can now complete PRO assessments via SMS.
  • All of CODE’s PRO Modules include patient-reported complications tracking and patient experience questions. This gives you the data you need to look for correlations, identify problem areas, and practice evidence-based decision making.
  • We can send your data directly to CMS, all you have to do is ask.

To learn more how CODE Technology makes the collection of outcomes easy and effective, contact an outcomes expert.

About the Author

CODE Technology

CODE Technology

We’re research nerds, and we believe Patient-Reported Outcomes are going to transform healthcare for the better - and we’re not alone. That is why we’re helping organizations collect and interpret as much data as possible, as efficiently as possible. Let us help you help the world.

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