School of Public Health in Boston,
Mass.
Others say reform will center on
making insurance affordable by get-
ting healthy people to pay into the
system. "But if you have a system
where funding is eliminated for
people to purchase insurance and
other requirements in place require
insurance to be sold to individuals
at any time, Republicans will be
forced to solve many of the same
issues Democrats faced while trying
to get the ACA passed," says Ankur
Goel, JD, a partner at McDermott
Will & Emery, a Washington, D.C.-
based healthcare law firm.
What will become of payment reform?
The Obama administration aggressively rolled out payment reform
programs. It also covered new ground by making the programs
mandatory and integrating the silos of surgical and medical care. For
example, CMS launched the Comprehensive Care for Joint
Replacement (CJR) model in April 2016. The bundled payment plan
pays hospitals a single fee for an episode of care, which begins at hos-
pital admission and extends to 90 days post-op. The program is
designed to eliminate the significant variation in Medicare reimburse-
ments for inpatient total hip and knee procedures performed in differ-
ent parts of the country. There's been talk of expanding and imple-
menting bundled payments in the outpatient setting, says Sheila
3 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 6
"It's a bit of an irony:
eliminating exchanges in
one market and creating
them in another."
— Piper Su, legislative and
health policy strategist
