CMS dips further into Medicare bundled payments. This time with cardiac care

Dive Brief:

  • On Monday, CMS released a notice of proposed rulemaking that would create bundled payment models for cardiac care.
  • The proposed payment model, among many goals, will seek to reduce costs for Medicare beneficiaries who have experienced a heart attack or bypass surgery. Heart attacks and strokes lead to more than $300 billion of healthcare costs annually, the agency stated.
  • This is the second bundled payment model CMS has proposed. Last November, the agency finalized the Comprehensive Care for Joint Replacement model.

Dive Insight:

The shift to quality-of-care continues as the agency seeks to create incentives for hospitals to participate in the bundled payment models. HHS has set the goal of tying 50% of traditional Medicare payments to alternative payment models – including ACOs and bundled payments – by the end of 2018. 

HHS noted more than 200,000 Medicare beneficiaries were hospitalized in 2014 for heart attack treatment or underwent bypass surgery, costing Medicare over $6 billion. "However, the cost of treating patients for bypass surgery, hospitalization, and recovery varied by 50% across hospitals, and the share of heart attack patients readmitted to the hospital within 30 days varied by more than 50%," HHS stated.

The cardiology industry is waking up to population health/value-based care efforts as well. At this year's American College of Cardiology's annual scientific meeting, ACC President Dr. Kim Allan Williams in his keynote opening speech gave a lot of time to the topic. He warned “if we don’t gain control,” cardiovascular mortality is projected to increase from 17 million in 2013 to over 23 million in 2030. He also noted ACC and its 52,000 members are in a great position to advocate for policies to provide cost effective care. 

What the NPRM proposes

Under the proposed model, a hospital for an admitted patient for a heart attack, bypass surgery or surgical hip/femur fracture treatment would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge.

In addition to the new cardiac care bundled payment models, the NPRM would establish a two-part cardiac rehabilitation incentive payment based on the total cardiac rehabilitation use of beneficiaries attributable to participant hospitals.

The NPRM also proposes ways for bundled payment-participating physicians to qualify for rewards via the proposed Quality Payment Program, which implements MACRA. "The bundled payment models proposed in today’s rule – as well as the Comprehensive Care for Joint Replacement model, which began this year – could qualify as Advanced Alternative Payment Models beginning in 2018 for physicians who collaborate with hospitals participating in the models," HHS noted in a prepared statement.

The policy would be rolled out in phases over five years beginning July 1, 2017 for hospitals in 98 metro areas (randomly selected) participating in the model. Similar to the joint bundled payment model, the cardiac care bundled payment policy would be mandatory, Modern Healthcare reported.

"Because the hip/femur fracture surgeries model builds upon the existing CJR model, CMS proposes to test these bundled payments in the same 67 [metro areas] that were selected for that model," the agency stated.

The rule will be published in the Federal Register on July 26 and public comment can be submitted 60 days after publication.

Follow on Twitter

Filed Under: Payer
Top image credit: Clipart Sheep