Policy experts ask HHS to test bundled payments for cardiac procedures

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A coalition of physicians, health policy experts and interest groups called on HHS to set up more mandatory pilot programs to test out bundled payment models within Medicare.

Released through the liberal-leaning think tank Center for American Progress, the letter to HHS Secretary Sylvia Burwell encourages the agency to quickly set up further demonstrations similar to its Bundled Payments for Care Improvement (BCPI) program before a new president is sworn in next year.

“Additional mandatory demonstrations would send an important signal to stakeholders—hospitals, physicians, device manufacturers, skilled nursing facilities and home health care agencies—that Medicare plans to aggressively expand bundled payments alongside other payment reforms,” the letter said.

BCPI’s Model 1, which covered payments for acute care hospital inpatient services, is scheduled to end at the end of the year. The letter suggests HHS use the results of that demonstration to launch a new pilot based on procedures such as coronary artery bypass grafting (CABG), stent placement, cardiac catheterization, pacemaker placement, and congestive heart failure.

“There is a wide variation in Medicare spending for episodes around CABG, suggesting the potential for substantial savings,” the letter said. “According to one study, the difference between hospitals in the highest-cost quintile and hospitals in the lowest-cost quintile was $23,833, or 70.2 percent. Much of this variation can be explained by differences in prices, suggesting that bundled payment can address price in addition to utilization.”

Among the signatories on the letter are former CMS Administrator Don Berwick, MD, Ezekiel J. Emanuel, MD, PhD, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and Alice Chen, MD, executive director of Doctors for America.