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Medicare Proposes Bundled Payments for Cardiac Care

By HealthLeaders Media News  
   July 26, 2016

The first mandatory bundled payment models for heart attack and coronary artery bypass procedures would begin in the summer of 2017.

First came Medicare's bundled payments program for joint replacements. Then came its  oncology bundling model. On Monday, Medicare announced a program for cardiac-care bundled payments.

Under the proposed rule, cardiac-care bundled payments would begin next July in 98 randomly selected metropolitan areas.


Related: Ready or Not, Here Come Bundled Payments


During a conference call Monday with members of the media, Patrick Conway, MD, acting principal deputy administrator and chief medical officer of the Centers for Medicare & Medicaid Services, described three policies included in the proposal:

  • New bundled payment models for cardiac care and the extension of the joint model to include treatment for hip and femur fractures;
  • A new model to increase cardiac rehabilitation;
  • A proposed pathway for clinicians and physicians in bundled payment models to qualify for payment incentives under MACRA.

Conway described the models as a major step to improve care, which builds off of CMS's Million Hearts initiative. That program "is focused on prevention, and these new payment models, which are focused on medical services and rehabilitation, we are providing a comprehensive payment system that doesn't just emphasize treating a disease but instead on maintaining health," he said.

Medicare has an opportunity to promote value in the delivery of cardiac care, Conway added. "In 2014, more than 200,000 Medicare beneficiaries were hospitalized for heart attack treatment or underwent bypass surgery, costing Medicare over $6 billion. But the cost of treating patients varied by 50% across hospitals and the share of patients readmitted to the hospital within 30 days varied by more than 50%. And patient experience also varied."

Cardiac Care Bundled Payment Details

Under the proposed cardiac-care bundled payments, hospitals would receive quality-adjusted pricing for heart attack and bypass episodes of care including 90 days after a hospital inpatient stay, according to a CMS factsheet.

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