News: CMS proposes bundled payment models for cardiac and hip fracture care

CMS is proposing development of bundled payment models for cardiac care and hip surgeries, according to a July 25 announcement. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery. The proposed rule also would expand the existing Comprehensive Care for Joint (CJR) Replacement model to include other surgical treatments for hip and femur fractures beyond hip replacement.

The proposals qualify as Advanced Alternative Payment Models (APMs) and qualify for financial incentives in the proposed Quality Payment Program under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), says CMS.

Under the new models, hospitals admitting Medicare patients for heart attack, bypass survey, and surgical hip/femur fracture would be accountable for the quality and costs of care provided from the time of the hospital stay through 90 days post-discharge.

The MS-DRGS included in the acute myocardial infarction (AMI) bundle include medical treatments and revascularization via percutaneous coronary intervention (PCI). However, CMS defines AMI episodes under the bundled payment models as medical treatment only. Including PCI would force hospital leaders to examine the efficiency of PCI treatment of AMI, reports The Advisory Board.

Once the models are in full effect, participating hospitals would be paid a fixed target price for each care episode, based on historical cost data. Hospitals that deliver higher-quality care would receive a higher target price.

Participation in the models will be mandatory for 98 randomly-selected hospitals, including 67 facilities already using the Comprehensive Care for Joint Replacement model. CMS would phase in implementation of the new payment models over five years.

For more information on the proposed bundled payments, click to view the CMS fact sheet.