CMS Proposes Cancellation of Cardiac Pay Models; Revision of CJR Model

August 2017 ~

On August 15, CMS issued a proposed rule to cancel the mandatory Episode Payment Models (EPM) and Cardiac Rehabilitation (CR) Incentive payment model, and make changes to the Comprehensive Care for Joint Replacement (CJR) Model.

Following a number of delays to the effective date of the EPM and CR models, the proposed rule was published in the Federal Register on August 17, with a scheduled effective date of January 1, 2018.

Under the rule, CMS is proposing to end the EPM program, which bundled reimbursement for acute myocardial infarction and coronary artery bypass graft care episodes. The rule would also put an end to the CR program, which encouraged the use of cardiac rehabilitation services during an EPM cardiac episode.

In its proposal, CMS noted that “large mandatory episode payment model efforts” may inhibit later testing of future bundled payment models with volunteering providers, and that canceling the EPM and CR models would provide hospitals with the flexibility to test other bundled payment models on a voluntary basis.

According to CMS, if passed, the rule will reduce the number of Metropolitan Service Areas (MSAs) with mandatory hospital participation by approximately 50%, with 34 of the original 67 MSAs still required to participate. Of the 34 participants, MSAs with low-volume and rural hospitals will have the option to participate on a voluntary basis, informing CMS of their intent to participate in the program starting January 1 through January 31, 2018.

The hospitals in the remaining 33 MSAs for CJR will also have the option to participate on a voluntary basis and will also be required to inform CMS of their intent to participate in the program between January 1 and January 31, 2018. These MSAs include the St. Louis, Kansas City, and Columba, Missouri MSAs, the Albuquerque, New Mexico MSA, and the Indianapolis, Indiana MSA.

Comments on the proposed rule may be submitted to CMS through October 16.

For more information the CJR program, see CMS’ Comprehensive Care for Joint Replacement Model page.

Complete details on the proposed rule can be viewed here.


Source(s): Department of Health and Human Services; Federal Register; Modern Healthcare; CMS Press Release; Becker’s Hospital Review;