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.
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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.
"Specifically, once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price," the factsheet says.
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There would be a phased-in process for downside and upside risk in the cardiac-care bundled payments from July 2017 to December 2021, the factsheet says.
Downside risk is slated to start in 2018, beginning with a 5% downside payment penalty cap from April 2018 to December 2018, a 10% payment penalty cap in 2019, and a 20% payment penalty cap in 2020 and 2021.
Upside payment rewards are slated to start next July, with shared savings payments capped at 5% from July 2017 to December 2018, 10% in 2019, and 20% in 2020 and 2021.
In 45 geographic regions, hospitals would be given a payment incentive to provide cardiac rehabilitation services. "Hospitals may use this incentive payment to coordinate cardiac rehabilitation and support beneficiary adherence to the cardiac rehabilitation treatment plan to improve cardiovascular fitness," the CMS factsheet says.
Cardiac care patients would benefit significantly from higher utilization of rehabilitation services, Conway said.
"Currently, only 15% of heart attack patients receive cardiac rehabilitation, even though completing a rehabilitation program can lower the risk of a second heart attack or death. Patients who receive cardiac rehabilitation are assigned a team of healthcare professionals such as cardiologists, dietitians, and physical therapists to help the patient recover and regain cardiovascular fitness," he said.
The public comment period on the proposed bundled payments rule for cardiac care and expanded orthopedic surgery is expected to close at the end of September.