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CMS Proposes Bundled Payments for Cardiac Care, Hip Fracture

The Centers for Medicare & Medicaid Services (CMS) has proposed new episode payment models for cardiac care and extending the joint model to include treatment for hip and femur fractures.

Advancing Care Coordination Through Episode Payment Models would test three new models:

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

For the new cardiac bundles, CMS would include acute care hospitals in 98 randomly selected metropolitan statistical areas (MSAs). As the hip/femur fracture surgeries model builds upon the existing Comprehensive Care for Joint Replacement model, CMS proposed to test these bundled payments in the same 67 MSAs that were selected for that existing model.

As part of the five-year models, beginning July 1, 2017, hospitals would 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. Consideration and adjustments for transfers for cardiac care are provided in the proposed rule. CMS proposed to phase in the repayment responsibility, beginning in performance year two.

CMS also proposed a cardiac rehabilitation incentive payment model to encourage use of cardiac rehabilitation services among beneficiaries hospitalized for treatment of AMI or CABG.

Last, CMS proposed a pathway for physicians with significant participation in bundled payment models to potentially qualify as Advanced Alternative Payments Models through the recently proposed Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act (MACRA).

Comments on the proposal are due to CMS by Oct. 3. America’s Essential Hospitals will send a more-detailed summary of the proposed 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.