Dive Brief:
- About 85% of hospitals that may be required to participate in Medicare's proposed new cardiac bundled payments can expect to see a modest impact that doesn't exceed about $500,000 per year, according to a new Avalere analysis that based its conclusions on 2013-14 spending data.
- However, a smaller proportion of hospitals are likely to experience significant penalties because their current spending is significantly above the average for their region.
- Some of those high-spending hospitals may have difficulty getting in line with average spending because they may be serving sicker populations that lack sufficient outside support to keep them from "bouncing back" for further costly follow-up care, Avalere found.
Dive Insight:
Those hospitals that end up being required to participate will have to look at multiple avenues for containing their costs. "Given the array of new cardiac bundles, there is no magic bullet to achieving savings," stated Fred Bentley, vice president at Avalere.
Primary efforts will include working closely with physicians to streamline care and adhere to clinical guidelines, as well as developing high-performance post-acute networks to reduce readmissions, Bentley said. The analysis also pointed toward targeting device spending and care management for both surgical and medically managed patients, for which it broke down differences in spending.
The models will be required in 98 randomly selected markets and are slated to be phased in beginning July 1, 2017. Comments on the proposed bundles are being taken through Oct. 3, 2016.
Some industry groups have suggested the cardiac care model poses a burden for safety-net hospitals and some others, such as those already subject to the Comprehensive Care for Joint Replacement (CJR) model. Also, as noted by Bloomberg BNA, when CMS announced the prosed CJR program it also announced the metro areas selected for participation, but when it announced the cardiac care model in July it did not specify the areas that would have to participate, making it impossible to prepare ahead of time.