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CMS Finalizes Bundled Payments for Cardiac Care, Hip Fracture

The Centers for Medicare & Medicaid Services (CMS) finalized new episode payment models for cardiac care and surgical treatment for hip and femur fractures. CMS also updated the Comprehensive Care for Joint Replacement (CJR) model, allowing it to qualify as an advanced alternative payment model (APM) under the new Quality Payment Program (QPP).

The Advancing Care Coordination through Episode Payment Models (EPMs) will test three new models:

  • acute myocardial infarction (AMI);
  • coronary artery bypass graft (CABG); and
  • surgical hip/femur fracture treatment, excluding lower extremity joint replacement.

For the new cardiac bundles, CMS will include acute care hospitals in 98 randomly selected metropolitan statistical areas (MSAs). As the hip/femur fracture surgeries model builds on the existing CJR model, CMS will test these bundled payments in the same 67 MSAs that were selected for that model, which began in April 2016.

As part of the five-year EPMs, beginning July 1, 2017, hospitals will be held financially accountable for meeting quality and cost measures for the entire episode of care, from the date of admission through 90 days post-discharge.

The final rule pushes back the implementation of downside risk for all participants in the EPMs from performance year 2 (Jan. 1, 2018) to performance year 3 (Jan. 1, 2019). However, participants interested in taking on downside risk earlier can choose to do so beginning in performance year 2.

Revisions to the proposed transfer policy for AMI episodes, as well as the quality measures for the CABG model, are also provided in the final rule. Further, the final rule provides additional exclusion from EPMs to Track 3 of Shared Savings Program accountable care organizations.

CMS also finalized a cardiac rehabilitation (CR) incentive payment model, beginning July 1, 2017, to encourage use of CR services among beneficiaries hospitalized for treatment of AMI or CABG.

These new EPMs and the updated CJR model, as finalized, will provide clinicians additional opportunities to earn incentive payments through the advanced APM path under the QPP, implemented as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

America’s Essential Hospitals will send a more-detailed summary of the final rule to members in coming days. Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.