Episode-Based Payment Model — Specialty Integration

CMS intends to incorporate more specialists into its bundled payment models, and the agency is asking for help designing the reimbursement mechanisms. Learn here what to do about it.


The Centers for Medicare & Medicaid Innovation Center recently asked for public comment on how to improve specialty care incentives in value-based care demonstration projects. CMS intends to incentivize better coordination of patient care by bundling payment to all of the clinicians involved during an episode of care, thereby reducing the financial reward of duplicative or unnecessary services. Over the past few years, the CMS Innovation Center launched several episode-based payment models — so-called bundled payment models — but they were narrow in scope, like the Comprehensive Care for Joint Replacement (CJR) pilot. In July, the Innovation Center released a Request for Information to gather stakeholder opinions about how to best design expanded episode-based payment models.


Public comments on episode-based payment models were due to CMS on August 17, 2023. CMS plans to move 100% of Medicare fee-for-service beneficiaries and the vast majority of Medicaid beneficiaries to an accountable care relationship by 2030.