The Centers for Medicare and Medicaid Services (CMS) has delayed the effective date for the second mandatory hospital bundling program issued in January.  AHCA/NCAL had requested that the Trump Administration carefully scrutinize the Episode Payment Models (EPM) final rule for possible significant changes or to completely rescind the rule.  This action delays the effective day of the regulation by 60 days, from an effective day of February 18, 2017 to an effective date of March 21, 2017. The implementation date for the EPM program and related changes to the comprehensive care for joint replacement (CJR) bundling demonstration remains July 1, 2017. 

AHCA is not opposed to bundles, but we are opposed to mandatory bundles, particularly when hospitals hold the bundle as required in this rule.

The January rule implemented three new mandatory EPMs: coronary artery bypass graft (CABG); acute myocardial infarction (AMI); and surgical hip/femur fracture treatment (SHFFT). The two cardiac episodes will be tested in 98 Metropolitan Statistical Areas (MSAs) across the country, while the SHFFT episode will be tested in the 67 MSAs currently participating in the Comprehensive Care for Joint Replacement (CJR) demonstration. 

Under the program, hospitals will be held accountable for total Medicare Parts A and B spending, as well as performance on certain quality measures, during 90-day episodes of AMI, CABG and SHFFT episodes, depending on where the hospital is located. Hospitals may share in risk and in savings with other provider types, including skilled nursing centers, but they are not required to do so. The EPMs will begin on July 1, 2017, and will run for almost five years, through 2021. Almost all of the new EPM policies mirror those in the CJR demonstration. All available CMS materials on these new EPMs are accessible online. View AHCA/NCAL’s announcement on the final rule here.

AHCA/NCAL applauds CMS’ actions and looks forward to future dialogue with CMS on its bundling efforts. According to AHCA/NCAL President and CEO Mark Parkinson, “This is the first regulatory relief we have received from the new administration, and we are hopeful that it is a sign of much more to come.”