New Medicare Bundled Payment Models Delayed until 2018

June 2017 ~

CMS has issued a new final rule titled, “Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR)” further delaying the start date of these payment models until 2018.

The release of the final rule marks the second delay for these payment models following the publication of the Interim Final Rule which postponed the start date of the new EPMs and the CR Incentive Model as well as certain changes to the CJR Model regulations intended to align the CJR Model with the EPMs from July 1, 2017 until October 1, 2017. Within the interim rule, CMS proposed further delaying the models until January 1, 2018 to align the payment periods with the calendar year.

The new EPMs will include episodes of care for:

  • Acute Myocardial Infarction (AMI EPM),
  • Coronary Artery Bypass Graft (CABG EPM), and
  • Surgical hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT EPM).

Under the final rule, all hospitals paid under the Inpatient Prospective Payment System (IPPS) and located in the 98 metropolitan statistical areas (MSAs) selected by CMS will be required to participate in EPMs to receive reimbursement for AMI and CABG services provided to Medicare fee-for-service beneficiaries. CMS will implement the SHFFT model in the 67 MSAs where the CJR program is already under way. An AMI, CABG, or SHFFT model episode will begin with an inpatient admission and end 90 days after beneficiary discharge.

Hospitals will be paid a fixed price, based on a target price, for each episode of care, including post-acute care received after discharge. The first performance year will run for a full 12 months, instead of the originally finalized six.

CMS has indicated that evaluation of Cardiac and SHFFT episodes will focus on assessing changes in care quality and efficiency including reduced health care costs. Evaluation of the Cardiac Rehab Incentive Payment model will focus more on assessing changes in utilization, retention, and duration of cardiac rehabilitation sessions.

These new payment models aim to provide clinicians additional opportunities to qualify for a 5% incentive payment through the Advanced Alternative Payment Model (APM) path under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program.

Source(s): MGMA; HealthcareDIVE; RevCycleIntelligence; Healthcare Financial Management Association (HFMA); Healthcare Finance News; Health Industry Washington Watch;