Statement on CMS Final Rule to Bundle Payments for Hip and Knee Surgery

Rick Pollack
AHA President and CEO
November 16, 2015

America’s hospitals have begun the challenging work of redesigning the way care is delivered to increase value and better serve patients. Today’s final rule from the Centers for Medicare & Medicaid Services (CMS) on bundled payments for hip and knee replacements takes several positive steps to provide the support hospitals need to be successful.

We are pleased that CMS and the Office of the Inspector General recognized the importance of assuring that participating hospitals can pursue the program’s goals without running afoul of fraud and abuse laws. These legal protections are critical to hospitals’ ability to coordinate care among all caregivers.

We also appreciate the delay in program’s start date until April 1, 2016, but remain concerned that hospitals will still be pressed to put in place the processes and procedures necessary for the program. Additionally, we appreciate that CMS made changes to the quality measurement provisions to allow more flexibility, while encouraging high-quality patient care. Finally, while we had urged CMS to limit the program only to elective knee and hip replacements, we appreciate that they recognized elective and non-elective procedures are clinically different and require different levels of resources.

We will continue to work with CMS and hospitals and health systems to improve care coordination for patients in a way that addresses the specific needs of individual communities, including for post-acute care providers to preserve the unique role they play in caring for these patients.

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About the AHA

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at www.aha.org.