CMS proposes bundled payment models for cardiac and hip fracture care

The Centers for Medicare & Medicaid Services today proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services. In addition, the proposed rule would expand the existing Comprehensive Care for Joint Replacement model to include other surgical treatments for hip and femur fractures beyond hip replacement. Under both the new cardiac bundled payment model and the expanded CJR model, the hospital in which the initial services are provided would be held accountable for the quality and costs of care for the entire episode of care from the time of the hospital stay through 90 days after discharge. The hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs based on its performance on cost and quality for the episode. The cardiac model would be mandatory for hospitals in 98 geographic areas across the country. The models would begin in July 2017. For more, see the CMS factsheet. “Hospitals are under a tremendous burden to help ensure these complex models work for patients,” said AHA Executive Vice President Tom Nickels, noting that this is the third mandatory demonstration project from the agency in a little over a year. “America’s hospitals are committed to improving care coordination thoughtfully and systematically in order to create better value for our patients and communities…We will fully analyze the proposals and we look forward to improving them so they are reasonable and workable for patients.” AHA staff are reviewing the proposed rule, and members will receive a Special Bulletin with further details.