February 01, 2018

CMS Reshapes the Playing Field for Innovative Payment Models

Christopher Dean, Kristen Bohl and Catherine Martin, Baker Donelson, Baltimore, MD

The Centers for Medicare & Medicaid Services (CMS) continues to reshape the playing field of innovative payment models by cancelling proposed programs, limiting the scope of a mandatory, nation-wide program, and suggesting that different innovation programs would be released in 2018.  In particular, CMS cancelled the moribund Episode Payment Model (EPM) and Cardiac Rehabilitation Incentive Payment Model (CR Incentive Payment Model) outright.1 The Comprehensive Care for Joint Replacement (CJR) Model witnessed its broad mandate reduced from hospitals within 67 Metropolitan Statistical Areas (MSAs) to 33 MSAs and also provided low volume and rural hospitals an opportunity to opt out of its requirements.2  These changes should simplify existing models and could indicate that future models will do more of the same.

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