News: CMS finalizes bundled payments for cardiac and ortho services

Continuing on its pay for performance agenda, CMS released information about new bundled payments related to cardiac diseases and hip replacements as well as a new Accountable Care Organization (ACO) opportunity for small practices, according to a December 20 release.

CMS says it paid more than $6 billion for heart attack treatment and bypass surgeries in 2014 but that the cost of such treatments, as well as percentage of 30-day readmissions, varied across the country. The release points to clinical trials which show rehabilitation improves patient outcomes but that only 15% of heart attack patients receive such care. The three new payment models related to heart attacks, heart surgery to bypass blocked coronary arteries, and cardiac rehabilitation.

The models aim to incentivize coordination of cardiac rehabilitation following discharge from the hospital for a heart attack or bypass surgery. Such payments will cover the same five-year period as the cardiac care bundled payment models, the release states.

For orthopedic considerations, CMS released one new payment model related to patients who receive surgery after a hip fracture beyond hip replacement. Providers will be accountable for the quality and cost of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge. The new models will operate over a period of five years beginning July 1, 2017. The surgical hip fracture treatment model will apply to hospitals in 67 metro areas, which are the same metro areas currently included in the Comprehensive Care for Joint Replacement Model, the release states.