CMS proposes mandatory cardiac bundled-payment pilot

A new mandatory program the CMS proposed Monday would make hospitals in 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks.

“We think it’s important to keep pushing forward on delivery system reform,” Dr. Patrick Conway, acting principal deputy administrator and chief medical officer for the CMS, told reporters in a call. “We think this is a huge opportunity.”

In 2014, hospitalizations for heart attacks for more than 200,000 beneficiaries cost Medicare over $6 billion, the CMS said. Yet for every treatment, the cost could vary by as much as 50%, the agency said.

The CMS is seeking comment on the five-year demonstration, which would take effect July 1, 2017, in 98 randomly selected metropolitan areas.

The CMS also plans to expand its first and mandatory bundled-payment model—which took effect in January and covers total hip and knee replacements—to include surgeries repairing hip and femur fractures.

Stakeholders and observers had long speculated that cardiac procedures would be next in the expansion of bundled payment models.

The change comes as part of a broader nationwide shift toward value-based payment systems that aim to reward doctors, hospitals and other providers for quality over quantity of care. The administration aims by 2018 to have half of traditional Medicare payments go through alternative payment models.

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