CMS released a rule on Tuesday that finalizes a mandatory bundled payment program for heart attacks and bypass surgeries and expands the existing Comprehensive Care for Joint Replacement model.
Here are 10 things to know about the final rule.
1. Under the final rule, acute care hospitals in certain markets will be accountable for the cost and quality of care provided to heart attack, coronary bypass and surgical hip and femur fracture patients beginning with hospitalization and extending 90 days after discharge.
2. The rule expands the existing CJR model to include additional surgical treatments for hip and femur fractures.
3. Hospitals will receive retrospective episode-based payments under the new bundles. Hospitals that spend less than the target price for the episode of care while meeting or exceeding quality standards keep the savings achieved. A hospital is required to repay Medicare if the costs exceed the target price.
4. The final rule includes a cardiac rehabilitation payment model, which will test whether a payment incentive can increase the utilization of cardiac rehabilitative services. These services have historically been underused by Medicare beneficiaries, according to CMS.
5. The heart attack and coronary bypass bundled payment model will be mandatory for hospitals in 98 metropolitan statistical areas. Approximately 1,120 hospitals will participate in the cardiac bundling model.
6. About 860 hospitals will participate in the hip and femur fracture bundles, which will be tested in the 67 MSAs already selected for the CJR model.
7. The cardiac rehabilitation payment model will be implemented in 90 MSAs, 45 of which were not selected for the heart attack and coronary bypass models. Approximately 1,320 hospitals will participate in the cardiac rehabilitation payment model.
8. The cardiac bundles and the expanded CJR model qualify as Advanced Alternative Payment Models under the Medicare Access and CHIP Reauthorization Act and the Quality Payment Program.
9. The American Hospital Association said it was pleased with some parts of the final rule, including the flexibility the rule provides regarding MACRA participation. However, the AHA expressed concern about the pace of change. "The bundled payment model for cardiac care is the second mandatory demonstration project the agency has finalized in just the past 15 months," said the AHA. "This is too much, too soon."
10. Under the final rule, the bundles will begin July 1, 2017.
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