CMS to test value-based reimbursement for cardiac care

Medicare bundled payment models, previously confined to hip and knee replacements, will now be applied to cardiac care for certain hospitals under a new demonstration announced by the Department of Health and Human Services.

The proposed payment models, which target heart-attack and bypass surgery procedures, will be eligible for incentive payments under the Medicare Access and CHIP Reauthorization Act's new alternative payment model beginning in 2018. HHS plans to pick 98 metropolitan areas to roll out the new program, and participation for the selected hospitals is mandatory.

Under the new bundled payment model for cardiac care, hospitals are responsible for cost and quality of care during both the inpatient stay and 90 days post-discharge, which HHS hopes will decrease readmission rates. 

HHS will also test incentive payments designed to increase the use of cardiac rehabilitation. Presently, only 15 percent of heart attack patients receive cardiac rehabilitation to regain cardiovascular fitness, HHS notes, even though clinical studies show rehabilitation programs can lower the risk of a second heart-attack or death.

In addition, HHS proposes to extend its hip and knee bundled payment model to include other surgical treatments for hip and femur fractures beyond hip replacement.

This reform could not wait until the results of the November elections, said Patrick Conway, M.D., Centers for Medicare & Medicaid Services acting principal deputy administrator, during a call with reporters. The move puts "patients at the center of the healthcare system," according to Conway, who added that it shouldn't be a politically charged issue.

Citing the need to transition away from a fee-for-service healthcare system, federal health officials intend to use alternate payment models for 50 percent of all Medicare payments by 2018, up from 30 percent in 2016. 

- read the CMS announcement

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