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 CMS Proposes New Mandatory Cardiac Bundle, Expands CJR And BPCI

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 speed recovery.
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 priorities.”
AHCA says it intends to submit “robust” comments to CMS on the proposed rule, which are due at the end of September.
More information can be found on the CMS website.
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