New payment models coming thick and fast

The Centers for Medicare & Medicaid Services last year set the ambitious goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by the end of 2016 and 50 percent by the end of 2018.

The agency announced in May that it had already met the 30 percent threshold through the implementation of models such as as Medicare accountable care organizations, the Bundled Payments for Care Improvement Initiative and the Comprehensive Primary Care initiative, among others. And the pace of adoption is only set to accelerate.

In spring, CMS launched the Comprehensive Care for Joint Replacement model, which bundles payment to acute care hospitals for hip and knee replacement surgery in 67 geographic areas. Under the mandatory model, the hospital in which the initial service is provided is held accountable for the quality and costs of care for the entire episode of care, from the date of admission through 90 days after discharge.

There are concerns that CMS is asking for too much, too soon, placing the success of these critical programs at risk.

In summer, CMS proposed to expand the CJR model to include surgical treatments for hip and femur fractures other than joint replacement. At the same time, CMS proposed a new bundled payment model for heart attack and cardiac bypass surgery services. The cardiac model would be mandatory for hospitals in 98 geographic areas across the country, although selection of the specific areas will not be made until the final rule.

While the American Hospital Association supports efforts to better coordinate care and worked to shape the agency’s hip and knee replacement bundle to make it work for hospitals and patients, the cardiac bundles are the third mandatory demonstration project from CMS in a little more than a year. There are concerns that CMS is asking for too much, too soon, placing the success of these critical programs at risk. Hospitals need the agency to support them by recognizing the significant investments of time, effort and finances required to be successful under these models.

The AHA is actively monitoring these new delivery models and continuously providing input to CMS on how to improve them. I urge you to view the resources the AHA has available at and start a conversation with your board about how your hospital is preparing for and responding to the new models and the move from volume to value.

Margaret Dahl ( is chair of the American Hospital Association Committee on Governance and a trustee of WellStar Health Network ACO in Marietta, Ga.