What you need to know?

  • The cardiac bundled payment models apply to cardiac care and extend the existing Comprehensive Care for Joint Replacement (CJR) model to include hip and femur fractures. The cardiac bundles will include CABG, AMI, and PCI.The AMI episode payment model (EPM) would include medical treatment of AMI (MS-DRGs 280-282) and AMI treated with revascularization via PCI (MS-DRGs 246-251). The CABG EPM would include MS-DRGS 231-236.
  • The cardiac bundles make hospitals accountable for the cost and quality of care provided during the inpatient stay and for 90 days after discharge.
  • The final rule identifies 98 MSAs (list and map can be found below) for the cardiac bundles program. CJR already includes 67 MSAs.
  • Hospitals will receive quality-adjusted target payments for each episode of care that will be based upon a blend of regional price and hospital price.
  • Composite quality scores will figure into the target price.
  • The bundles are set to begin on July 1, 2017 with the first performance period ending December 31, 2017.
  • At the end of each reconciliation year, hospitals that meet quality standards can earn additional payments based on cost. Those that exceed the target price will owe Medicare.
  • The models also include incentives for cardiac rehabilitation services with reimbursement starting at $25 per rehab service initially and increasing to $175 after the first 11 services are delivered. CR is up to 36 sessions and ICR is up to 72 sessions.
  • Cardiac rehabilitation incentive payments will be tried in 45 Cardiac Bundle MSAs and in 45 non-Cardiac Bundle MSAs.
  • Cardiac bundles and CJR will qualify as Alternative Payment Models (APMs) under MACRA, and provide an exemption from the Quality Payment Program for providers who participate.
  • This final rule includes legal waivers for telehealth, 3-day hospital stay and other incentives to include novel approaches to follow-up care.
 
Are you on the map?

Click the map below to visit CMS’s Episode Payment Models: General Information web page. Scroll down to review the full list of final MSAs selected for Cardiac, CJR of SHFFT bundled payments.

 
map
 
Timeline
 
Cardiac Timeline
Cardiac Bundles Webinar

WEBINAR: The NEW CMS Cardiac Bundles - Everything You Need to Know Now

Get a better understanding of this proposed rule, its timeline and its financial impact to your bottom line. (Created before ruling was final)

How HealthLoop Can Help

Hospitals can improve quality and margin with the use of HealthLoop to engage and monitor patients.

  • Heathloop's empathic guidance and instructions help patients engage in their care plan with understanding how to achieve the best outcome.
  • HealthLoop can continuously monitor patients after discharge to ensure they are recovering normally and adhere to their care plan.
  • HealthLoop can identify patients with adverse events early, so your care management teams get notified of issues before they become costly or life threatening.
  • Because cardiac rehabilitation (CR) programs have been proven to be so successful in improving long term outcomes, CMS is providing a balloon payment of up to $4,650 for cardiac rehab and $10,950 for Intensive Cardiac Rehab (ICR) programs by getting patients engaged and seeing them through. Only 11% of patients currently complete their cardiac rehab program. HealthLoop can continuously encourage your patients to get in the program and comply with their rehabilitation.
Helpful Links

Episodic Payment Models cover numerous new reimbursement schemes from CMS, including cardiac care as well as surgery after a hip fracture, other than hip replacement. These two models are described at the link below.

Episodic Payment Model - Fact Sheet

Overview of Episode Payment Models (EPMs)

EPM Final Rule