AAOS objects to CMS' mandatory bundled payment model: 5 notes

Written by Jessica Kim Cohen | September 08, 2016 | Print  |

The American Academy of Orthopaedic Surgeons submitted a four-page letter to the House Budget Committee hearing on the Center for Medicare & Medicaid Innovation, which took place Sept. 7. In the letter, AAOS raised concerns about how the new Medicare bundled payment model for joint replacement surgery, which began in April, would impact orthopedic payments.

Here's what you need to know:

 

1. The new joint replacement surgery payment model, called the Comprehensive Care for Joint Replacement model, is the first-ever mandatory bundled payment model issued by CMMI. Its goal is to encourage healthcare providers to work together through the first 90 days following operation.

 

2. Although CMS has called the CJR model a cost-saving and quality-improvement program, AAOS emphasized that since there is little reliable data about similar programs, it is "nearly impossible" to estimate future savings.

 

3. AAOS is also concerned that this program financially penalizes physicians who perform joint replacement surgeries on disadvantaged patients, since these patients will likely require increased levels of care and longer rehabilitation.

 

4. AAOS encouraged CMS to consider a gradual transition from voluntary to mandatory implementation when introducing new payment models, rather than instituting mandatory models with short implementation timeframes. The society says this additional time will allow practices to familiarize themselves with new business and clinical pathways.

 

5. The letter also notes that a preliminary voluntary program would allow for "best practices in bundled surgical care to be identified," while also allowing providers to tailor the models to their patient population.

 

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