CMS Announces Additional Mandatory Bundled Payment Models, ACO Track 1+

CMS is moving full-steam ahead with the transition to value-based care. On Tuesday, the agency announced 3 new bundled payment models in cardiac care, an expansion on the Comprehensive Care for Joint Replacement Model (CCJR), and the highly anticipated new track in the Medicare Shared Savings Program (MSSP).

The new announcements provide additional opportunities for providers to participate in the Medicare Access and CHIP Reauthorization Act (MACRA) under the Advanced Alternative Payment Model (APM) path, according to CMS.

The cardiac payment model includes: the Acute Myocardial Infarction (AMI) Model; the Coronary Artery Bypass Graft (CABG) Model; and the Cardiac Rehabilitation Incentive Payment Model. AMI and CABG will be implemented in 98 areas and rehabilitation model will be implemented in 90 geographic areas, half of which overlap with areas that were also selected for the AMI and CABG Models. The CCJR is being expanded in the current CJR areas to include surgeries for hip and femur fractures. The models will begin on July 1, 2017 and run until December 31, 2021, plus they count as participation in an Advanced APM under MACRA, which means clinicians qualify for a 5% incentive payment.

There are some who remain opposed to the mandatory nature of the bundled payment models for cardiac care and hip and knee replacement. Tom Nickels, executive vice president of government relations and public policy of the American Hospital Association (AHA), called it “too much, too soon.” The pace of change leaves AHA concerned.

“While it is important to test new payment models, hospitals should not be forced to participate in complicated new programs if the government has not already proven that they will benefit the patients we serve,” he said. “We will continue to urge that any new bundled payment programs be of a voluntary nature.”

Another opponent? Representative Tom Price, R-Georgia, who is President-elect Donald J. Trump’s pick to run HHS. On September 29, Price and other members of Congress wrote to CMS Acting Administrator Andy Slavitt and Patrick Conway, MD, MSc, deputy administrator of innovation and quality and chief medical officer of CMS, that mandatory payment reform exceeds the authority of the Center for Medicare and Medicaid Innovation (CMMI).

“We insist CMMI stop experimenting with Americans’ health, and cease all current and future planned mandatory initiatives within the CMMI,” the letter said.

It seems likely that Price will scrap plans for the mandatory bundled payment models.

CMS also announced Track 1+, a new accountable care organization (ACO) model under MSSP. The new track has more limited downside risk than Tracks 2 and 3. The Track 1+ model qualifies participating ACOs for the Advanced APM path. Since the model is based on the current Track 1 model there is a maximum 50% shared savings rate, something that Farzad Mostashari, MD, founder of Aledade noted on Twitter:

Good news: ACO Track 1+ is out.

A qualifying AAPM with tolerable downside risk

Bad news: same shared saving % 😑

https://t.co/u5YeT2GZdK

— Farzad Mostashari (@Farzad_MD) December 20, 2016

He did also note that having the new Track 1+ model is better than not having it at all, although it might be a hard sell. The new track is one that healthcare organizations including the National Association of ACOs, AHA, and the American College of Physicians had urged CMS to implement.

“This new ACO model will allow hospitals and clinicians to partner to provide high-quality, cost-efficient care for patients without incurring the unsustainable financial risk that current ACO models require,” Nickels said in a separate statement. “We have recommended CMS better balance risk and reward for its ACO models, and based on the details in the CMS fact sheet, Track 1+ is a move in the right direction.”