This article is more than 5 years old. Information may no longer be current.
CMS finalizes new cardiac, orthopedic bundled payment models
Click Here to Manage Email Alerts
The CMS recently announced the finalization of new Innovation Center models for orthopedics, cardiology and small practices that continue the shift in Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost.
“Today, we are proud to continue progress strengthening Medicare for beneficiaries, providers and taxpayers with alternative payment models that reward the quality of care over quantity of services,” Sylvia M. Burwell, secretary of the HHS, said in a press release. “These models give providers and hospitals the tools they need to provide the kind of high-quality patient-centered care we all want for our own families, while also driving down costs for the nation.”
Cardiac, orthopedic care models
CMS noted these new payment models — the Acute Myocardial Infarction (AMI) Model, the Coronary Artery Bypass Graft (CABG) Model and the Surgical Hip and Femur Fracture Treatment (SHFFT) Model — will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries and who receive surgery after a hip fracture, other than hip replacement. A Medicare episode quality-adjusted target price will be established by CMS for each participant hospital that will include payment for all related services furnished to eligible Medicare fee-for-service beneficiaries. Participating hospitals will also earn a composite quality score based on the quality of care previously provided, according to CMS. Hospitals may receive additional payment from Medicare if their overall spending on the episode of care is under the overall target price. Similarly, CMS noted hospitals that spent more than target price may have to repay Medicare for a portion of the episode. Overall, 98 geographic areas will be included as participants in the AMI and CABG models and 67 geographic areas will be included in the SHFFT model, according to the CMS.
A fourth model, known as the Cardiac Rehabilitation Incentive Payment Model, will test whether a payment incentive can increase the use of cardiac rehabilitative services, according to CMS. The Cardiac Rehabilitation Incentive Payment Model is a two-part cardiac rehabilitation incentive payment that will be paid retrospectively based on the total cardiac rehabilitation use of beneficiaries attributable to participant hospitals and limited by coverage requirements for cardiac rehabilitation and intensive cardiac rehabilitation. During the care period for an AMI or CABG care episode, Medicare will pay $25 per cardiac rehabilitation service for each of the first 11 services, and $175 per service during care period after 11 services.
The performance period for these four payment models will begin on July 1, 2017 and run until December 31, 2021.
CJR update
The CMS also noted several modest adjustments in the final rule to the Comprehensive Care for Joint Replacement (CJR) Model, including:
– refinements for use of the skilled nursing facility waiver;
– exclusion of beneficiaries participating in selected Accountable Care Organizations (ACOs); and
– revising target pricing methodology to include reconciliation and repayment amounts for performance years 3, 4 and 5.
CJR will now align with the episode payment models around financial arrangements and beneficiary engagement incentives, compliance enforcement, appeals processes and beneficiary notifications, according to CMS. Currently, CMS is finalizing revisions to the quality adjustment to incorporate improvement as well as absolute performance.
New ACO model
Finally, beginning in 2018, the new Medicare ACO Track 1+ model will allow clinicians to join Advanced Alternative Payment Models to improve care and potentially earn an incentive payment under the Quality Payment Program, according to CMS. Based on Shared Savings Program Track 1 with a maximum 50% shared savings rate, the Medicare ACO Track 1+ also incorporates elements of Track 3, including:
– prospective beneficiary assignment to allow ACOs to know in advance the patient population for which they are responsible;
– choice of symmetrical thresholds from which to start sharing in savings or losses; and
– the option to elect the skilled nursing facility 3-day rule waiver to provide greater flexibility to Track 1+ ACOs to better coordinate and deliver high quality care.
To encourage more rapid progression to performance-based risk, the CMS noted the Medicare ACO Track 1+ model will test a payment model that incorporates more limited downside risk than is currently present in tracks 2 or 3 of the Medicare Shared Savings Program.
References:
https://downloads.cms.gov/files/cmmi/epm-finalrule.pdf
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-12-20.html