​In a final rule that makes major changes to the mandatory bundled payment programs started under President Obama, the Centers for Medicare & Medicaid Services (CMS) scrapped the most recent bundling programs for cardiac episodes and altered aspects of the original Comprehensive Care for Joint Replacement (CJR) mandatory bundle by reducing the effort’s footprint.

On the first move, CMS had previously delayed the cardiac bundle programs until Jan. 1, 2018, but this final rule eliminates them altogether. In addition to the two cardiac bundles that were eliminated, the Surgical Hip and Femur Fracture Treatment (SHFFT) was eliminated as well.

For the initial CJR bundle program, the agency shrunk the number of Metropolitan Statistical Areas (MSAs) included in the demonstration from 67 to 34. In addition, low-volume and rural hospitals will not be required to participate.
As for the 33 MSAs that are being eliminated, CMS said bundling might continue but only on a voluntary basis.
“While CMS continues to believe bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and access to care,” said CMS Administrator Seema Verma. 
She added that additional announcements are in the offing for providers to voluntarily participate in bundles. 
On top of the final rule, CMS also issued an interim final rule seeking comment on a policy to provide flexibility in determining episode costs for providers located in areas impacted by extreme and uncontrollable circumstances, such as the hurricanes that occurred throughout the South and Southwest earlier this year.
The long term and post-acute care profession has been on the record as supporting bundled payment programs as Medicare seeks to reform payment under the wider umbrella of value-based care. However, the American Health Care Association/National Center for Assisted Living, while not opposed to bundling, has taken a position against mandatory bundling.
Read the final rule at: