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Expert: Trump administration 'buying time' by delaying bundled payment programs

Archway Health CEO said he doesn't believe the delay means the administration is moving away from value-based reimbursement.

Jeff Lagasse, Associate Editor

HHS Secretary Tom Price discusses healthcare policy with industry thought leaders. (via Twitter)HHS Secretary Tom Price discusses healthcare policy with industry thought leaders. (via Twitter)

The Department of Health and Human Services will be delaying the implementation of two bundled payment programs from the Centers for Medicare and Medicaid Services, and according to an expert, the Trump administration is likely doing this to buy time while the dust from the healthcare shake-up settles.

The bundled payment programs for hip and knee replacements was slated to expand Tuesday, while a new stroke and heart attack care program was planned for implementation the same day. Those changes are now being delayed until May 20. Originally, the changes were supposed to take place on Jan. 21, but the Trump administration ordered a 60-day regulatory freeze upon taking office.

"It appears to me that they're just kind of buying time," said Dave Terry, CEO of Archway Health, a firm specializing in managing bundled payment programs. "Obviously there's a lot going on right now with CMS, with the healthcare reform bill and the new head of CMS being appointed within the past couple of weeks. I think they're giving themselves some more time."

[Also: CMS delays 2 bundled payment programs]

According to a Federal Register notice released on Monday, the extra delay "is necessary to allow time for additional review, to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if policy modifications are warranted," and to make sure its participants understand the rules and how to comply with them.

HHS Secretary Tom Price has said he wanted to review bundled payment programs. In the past, he's been a vocal opponent to these types of reimbursement models.

But Terry said it appears the administration, and the healthcare industry, are likely moving full-speed ahead on the shift from volume to value, with bundled payments representing a significant aspect of that sea change.

"The wheels are turning, moving from volume to value," said Terry. "The industry had adopted that and feels it's the right direction to go in. The Trump administration and Secretary Price have emphasized that as well."

What may ultimately change, he said, is the mandatory nature of bundled payment programs. Making them likely, he said, would not only be likely, but beneficial.

"Last year, CMS announced they're creating the advanced BPCI program, in part to meet the needs of MACRA," said Terry. "They have these advanced alternative payment models they're talking about. For gastroenterologists and other specialists, a bundle is the only way for them to participate in a BPM. So we've heard from Medicare that they're expecting to launch those rules this spring," he said.

"We actually think the voluntary programs are a much better option for driving change than mandatory programs," he said. "When physicians sign up for voluntary programs, they're incredibly engaged in reducing costs. When you voluntarily sign up for something, the C-Suite is engaged, and change can happen much more swiftly and much more rapidly."

Most of the providers who have been put into a mandatory program don't show the same level of engagement, Terry said, and in some cases they've been pushed reluctantly into those programs.

HHS is also seeking comment about potentially delaying the start of the cardiac care program, and the expansion of the joint replacement program, until Jan. 1, 2018.

Twitter: @JELagasse

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