The Centers for Medicare and Medicaid Services late last month revealed a proposed set of new payment models, including bundled payments for cardiac care and cardiac rehabilitation services.
The new bundled payment model for cardiac care is designed to “improve the quality of care and reduce costs for beneficiaries” who had a heart attack or are undergoing bypass surgery, CMS said.
Through the proposed systems, hospitals would be provided with a fixed target price for each care episode for patients admitted for care of a heart attack or bypass surgery, with higher target prices for hospitals that deliver higher-quality care, according to a CMS release.
Upon ending the model performance year, actual spending for the episode would be compared to the target price that reflects episode quality for the responsible episode the group said. Hospitals with costs exceeding their quality-adjusted price target would be required to repay Medicare.
Each year, CMS will set target prices for different episodes based on historical data on costs for cardiac patients, with target prices adjusted based on the complexity of treating a heart attack or performing a bypass surgery. Prices will be based on a blend of hospital-specific data and regional historical data.
Higher quality care will result in higher payments, CMS said, with an individual hospital’s quality-adjusted target price based on a 1.5% to 3% discount rate relative to historical spending.
To adjust to the new models, CMS will implement the model in phases, with no repayment necessary for 1 year and 1 quarter, of the 2nd year, 5% capped repayments through year 2, 10% for year 3 and 20% for years 4 and 5. The 1st performance period is slated to run from July 1, 2017 to December 31, 2017.
CMS also proposed a new model of bundled payments for cardiac rehabilitation services.
The newly unveiled model would provide incentive payments to hospitals treating covered patients for heart attacks or bypass surgery based on “utilization of cardiac rehabilitation and intensive cardiac rehabilitation services in the 90-day care period following hospital discharge,” according to a notice from CMS.
Hospitals operating under the model would receive coverage for coordinating cardiac rehabilitation and supporting adherence to the rehab plans in hopes of improving cardiovascular fitness and outcomes. Testing of the model will take place in the same 45 geographic areas covered by the bundled cardiac care plan and will cover a 5-year period.
The payment plan will operate in 2 parts, CMS, with an itial payment of $25 per cardiac rehabilitation for the 1st 11 services and $175 per service past the 11th. Standard medicare payments for cardiac rehab services would continue throughout the model, CMS added.
The number of cardiac rehabilitation sessions covered by the program would be limited to a maximum of 2 1-hour sessions per day for up to 36 sessions over up to 36 weeks, with an option for an additional 36 sessions over an extended period of time if approved by a Medicare Administrative Contractor, CMS said. Intensive cardiac rehab program sessions would be limited to 72 1-hour sessions, up to 6 a day over up to 18 weeks.
