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CMS Delays Rollout of Cardiac, Ortho Bundled Payment Programs

CMS is instituting a three-month delay for some of its cardiac care and orthopedic bundled payment programs to give providers and rulemakers more time to prepare.

Bundled payment programs

Source: Thinkstock

By Jennifer Bresnick

- CMS is pushing back the start date for a number of its bundled payment programs in an effort to provide additional time to review and prepare for the initiatives.

In a notice posted in the Federal Register, CMS has issued three-month delays for the start of the Comprehensive Care for Joint Replacement pilot (CJR), the Cardiac Rehabilitation Incentive Payment Model, and three other Medicare cardiac care payment programs originally announced in December of 2016.

“This interim final rule with comment period (IFC) further delays the effective date of the final rule entitled "Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model" published in the January 3, 2017 Federal Register from March 21, 2017 until May 20, 2017,” stated CMS.

“This IFC also delays the applicability date of the regulations at 42 CFR part 512 from July 1, 2017 to October 1, 2017 and effective date of the specific CJR regulations itemized in the DATES section from July 1, 2017 to October 1, 2017. We seek comment on the appropriateness of this delay, as well as a further applicability date delay until January 1, 2018.”

The delays are necessary to allow time for additional review and to complete the comment and rulemaking process, the agency said.

This is the second delay for the cardiac bundled payment programs, which were subject to the Trump Administration’s temporary freeze on federal regulation issued on January 20, 2017.

The delays may have implications for providers who were hoping to use these bundled payment models during their MACRA attestation process.  CMS originally envisioned that the programs would help clinicians accrue incentives under the Alternative Payment Model (APM) track. 

But the new start dates may throw off those plans, potentially pushing more providers into MIPS instead – especially if CMS does push back the start dates until the beginning of 2018.

However, new CMS Administrator Seema Verma and HHS Secretary Tom Price believe that the start date delay is necessary, in light of the federal freeze, in order to provide stakeholders with enough time to participate adequately in the rulemaking and review process.

For more information on the delay, the Federal Register announcement is available here.


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