CMS Finalizes Plans to Bundle Cardiac Care Payments

Episode-based reimbursement for acute MI care and bypass surgery for Medicare fee-for-service beneficiaries will start in 98 metro areas as of July 2017.

CMS Finalizes Plans to Bundle Cardiac Care Payments

The US government has finalized its plans to test episode-based payments for heart disease treatment—in particular, acute MI care and bypass surgery—that will go into effect for a 5-year period in 98 metro areas as of July 2017.

Within these regions, which account for about one-quarter of metro areas nationwide, hospitals “will be accountable for the quality and cost of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge,” according to a Department of Health & Human Services press release issued yesterday. The new plans also incentivize cardiac rehab.

A fact sheet summarizing the contents of the nearly 1,800-page final rule can be found online.

First announced in July, the proposals were open to public comment until October 3. As reported by TCTMD at the time, cardiologists seemed disgruntled at the idea of lump-sum payments to hospitals. They aired anxiety over whether reimbursement would consider patient risk, the difficulties of coordinating postdischarge care, and the possibility that patients would be discouraged from receiving more costly treatments.

Comment released yesterday by the American College of Cardiology (ACC) hints at the uncertainty that many in the field feel.

“As we move from volume-based care to value-based care, this new path for cardiologists to participate in Advanced Alternative Payment models under MACRA’s Quality Payment Program is a challenging step. It is our sincere hope that the end result will be opportunities for coordinated care and improvement in quality, while also decreasing costs for patients with heart attack or who undergo bypass surgery,” said ACC President Richard Chazal, MD, in the prepared statement.

Also in a press release, Patrick Conway, MD, of the Centers for Medicare & Medicaid Services, commented: “As a practicing doctor, I know the importance of hospitals, doctors, nurses, and others working together to support a patient from heart attack or surgery all the way through recovery. These bundled payment models support coordinated care and can reward clinicians through the Quality Payment Program.”

  • Centers for Medicare & Medicaid Services. Advancing Care Coordination through Episode Payment Models (Cardiac and Orthopedic Bundled Payment Models) Final Rule (CMS-5519-F). Published on: December 20, 2016. Accessed on: December 21, 2016.