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What’s next after the cancelation of Episode Payment Models

Posted on: 02.08.18

After much debate, countless delays, and requests from providers to have more involvement in the process, CMS has canceled Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. While these payment models have been withdrawn, CMS’ focus on value-based care has not changed.

Back to the drawing board

The stated intention of original programs was to create payment models that help improve quality and care coordination while, at the same time, lower spending. The cancellation of Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model will now offer the CMS greater design and testing flexibility and the opportunity for more provider engagement. According to CMS Administrator Seema Verma, the new voluntary payment bundles are in the works and details will be announced soon.

The original models could have been modified to allow for voluntary participation on the planned January 1, 2018, start date. Still, CMS concluded that the extent of restructuring would not have allowed adequate time for providers to prepare, implement, and comply with the new requirements.

What’s next?

Looking forward, CMS plans to offer more voluntary initiatives, from which providers can choose to participate. Although some strongly believe that significant progress can only be made through mandatory efforts, evidence suggests that participation, and thus change, is positively affected by well-designed voluntary models.

Verma is a strong proponent of the voluntary models. Although she supports efforts around innovation, she’s somewhat skeptical of mandatory models. “We need to make sure we’re not forcing, not mandating individuals to participate in an experiment, a trial that there’s not consent around,” Verma said. The gradual expansion of the models and a smaller scale that allows ample time for evaluation is what will bring about change.



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