CMS bundled payments expand to cardiac care

CMS and the Center for Medicare and Medicaid Innovation (CMMI) announced additional mandatory regional participation in episodes of care, or “bundled payments” for acute myocardial infarctions (AMI), coronary artery bypass grafts (CABG) and surgical hip and femur fracture treatment (SHFFT).

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Frank

"Along with the similar mandatory Comprehensive Joint Replacement (CJR) bundle roll out this year, this expansion of CMS bundle payments is a clear sign that CMS bundle payment programs will continue to grow,” says Jeffrey Frank MD, program director of quality and performance for the hospitalist practice line at CEP America

Andy McNerney, MBA, manager with GE Healthcare Camden Group, agrees. “The fact that this program was proposed under the umbrella of ‘episode payment model,’ instead of tagged as a cardiac specific bundle indicates that more bundle mandates are likely to follow,” McNerney says. “The more traction that bundles gain, whether through market forces or mandates, the more providers will be incentivized to invest in reporting and analytic capabilities that track patients almost real-time. This real-time focus on standardization, best practice, and utilization management will push managed care executives to evaluate the value they can offer: Can you build/expand services and analytic tools to help providers be successful?”

According to Frank, CMS has already demonstrated savings and improved clinical outcomes with the voluntary Bundled Payments for Care Improvement (BPCI) pilot which has 415 acute care hospitals, 305 physician groups and 723 skilled-nursing facilities (SNFs) enrolled as episode initiators.

“Nearly all of these participants are dyads as awardee-the provider or hospital-with conveners, companies who enable management of the care bundles,” Frank says. “A care bundle is the associated diagnoses via DRGs and the 60 or 90 days of all post-acute care. The awardees-convener dyads have upside opportunity if they can provide care at a cost lower than the CMS target price after the Medicare 2% discount off the top. This 2% is a multibillion dollar savings for CMS at a time healthcare costs continue to rise.”

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Because post-acute care costs are up to 30% to 40% of total cost for these acute care diagnoses, post-acute care is an area of quality where readmissions and increased morbidity can be improved, and there is up to 50% variability in post-acute costs throughout the country, Frank says.

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