Adjusting a hospital's performance based on how old or sick the patient is already used in many other Medicare programs that assess health care quality and spending, the group asserted, and it could still be incorporated into the new system before it is fully deployed.

Leavitt and the former Bush administrators also recognized the possibility for the CMS to “refine its bundled payment proposal before it is implemented, and then through further improvements down the road,” particularly with reference to “quality and spending benchmarks need[ed] to account more thoroughly for differences across hospitals in patient risk, so that hospitals are not penalized for caring for the most complex patients.”


Ellimoottil and his study “found that changing the program to account for patient complexity would dampen this impact."

"While we believe that the Comprehensive Care for Joint Replacement program could serve as an important step in that direction, the inclusion of risk adjustment based on CMS-HCC risk scores would make the program more equitable for, and acceptable to, all participants, and would limit the potential unintended consequences for Medicare beneficiaries with multiple comorbid conditions," they concluded.

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