Cardiac and hip fracture gets new bundled payment models
The CMS has proposed new bundled payment models for high-quality cardiac and hip fracture care as part of continuing efforts to reward quality care at a lower cost.
The agency has also proposed an incentive payment program to encourage more use of cardiac rehabilitation.
The new models will create strong incentives for hospitals to work with physicians and other providers to reduce complications and hospital readmission rates and speed patient recovery, according to a notice of proposed rulemaking from the CMS.
The cardiac-care provisions include procedures related to caring for patients who require CABG or treatment for MI.
The new policies include:
- New bundled payment models for cardiac care and the extension of the current Comprehensive Care for Joint Replacement model to include other hip and femur fracture surgeries besides hip replacements.
- A new model that incentivizes physicians to increase the use of cardiac rehabilitation.
- A new pathway that allows physicians who participate in bundled payment models to receive payment incentives under the Quality Payment Program, an implementation of the Medicare Access and CHIP Reauthorization Act.
- The hospital which admits the patient for care for a MI, CABG or hip or femur fracture surgery will be responsible for the cost and quality of care provided to the Medicare patient for their hospital stay and 90 days after discharge. Hospitals will be paid a fixed price for all treatment. If a hospital delivers quality care at a price below the target, then it receives money back based on a per-patient formula at the end of the model performance year. When the cost of treatment exceeds the target, the hospital is required to reimburse Medicare.
Quality of care will be evaluated on:
- Hospital readmission rates,
- Emergency room visit rates,
- Amount of care deferred beyond the 90-day post discharge period,
- All-cause mortality rates,
- Hospital Consumer Assessment of Healthcare Providers and Systems satisfaction surveys and beneficiary surveys.
According to the CMS, the proposed models will also help reach the administration?s goal of 50% of traditional Medicare payments flowing through alternative payment models by 2018.
Improving quality care and value are central to the ACC?s strategic plan.?