The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule designed to
further the administration’s objective to shift Medicare payments from a
quantity to a quality basis. Under the proposal, new bundling models would reward
hospitals that work together with skilled nursing care centers, physicians, and
other providers to avoid complications, prevent hospital readmissions, and
The proposal implements a new, mandatory bundled payment model for certain
cardiac episodes. Participating hospitals in which a Medicare patient is
admitted for care for a heart attack or bypass surgery 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.
This model will be tested in 98 yet-to-be-selected Metropolitan
Statistical Areas (MSAs) representing about one-quarter of all the metropolitan
areas in the country. The proposed cardiac care policies would be phased in
over a period of five years, and would begin July 1, 2017.
The proposal also would implement a new incentive payment model
around cardiac rehabilitation to be tested in 90 MSAs. Half of the MSAs in this
model will be selected from the MSAs participating in the heart attack and
bypass surgery model.
In addition, CMS announced that the current Comprehensive Care for Joint
Replacement (CJR) program will be expanded by adding hip and femur fracture
episodes in the 67 MSAs that already have begun testing the model.
Finally, the proposal will establish a pathway for
physicians with significant participation in bundled payment models to qualify
for payment incentives under the recently proposed Quality Payment Program by
adding a new voluntary bundled payment model to the Bundled Payments for Care
Improvement (BPCI) initiative, which will be available in 2018.
CMS says that one of the major goals of bundled payments is to encourage
coordination and collaboration among all providers involved in a patient’s
care. As in the CJR model, CMS is proposing to allow hospital participants to
enter into financial arrangements with skilled nursing facilities and
physicians. Those arrangements would allow hospital participants to share
reconciliation payments, internal cost savings, and the responsibility for
repayment to Medicare.
The American Health Care Association (AHCA) says that these policies, if
implemented as they are currently proposed, likely would have a significant
impact on many of its members.
“This proposed rule is a bit
sudden given everything else we are currently dealing with, such as the
Requirements of Participation final rule, Medicaid managed care rule, and CJR
ramping up,” says Greg Crist, senior vice president for public affairs at AHCA.
“It’s a lot in a short period of time, leaving members questioning where they
should focus their limited resources and time given all these new CMS
AHCA says it intends to submit “robust” comments to CMS on the proposed
rule, which are due at the end of September.