Bundled payments for cardiac care, rehab will qualify for MACRA incentive payments, CMS says

The Centers for Medicare and Medicaid Services (CMS) proposed a new rule Monday that requires mandatory bundled payment models for cardiac care and rehabilitation while extending the existing bundled payment model for hip replacements to other hip surgeries.

The new mandatory bundled payment models will be phased in over a five-year period beginning in July 2017 and will qualify for incentive payments under MACRA beginning in 2018.

CMS said rather than applying for the new cardiac bundled payments, hospitals will be selected in 98 random metropolitan areas. Hospitals chosen for the program would be reimbursed a fixed amount for a specific care episode. The incentive for hospitals is that higher target prices are tied directly to higher-quality care.

"These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery," CMS said in its notice of proposed rulemaking.

Under the proposed payment models, CMS said, hospitals in which patients are admitted following heart attacks, bypass surgery, or hip/femur fracture treatment "would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge."

"Once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price," CMS said.

A number of hospital executives said at an April panel on Medicare payment system reform that the Medicare bundled payment joint replacement program has improved the quality of care delivered to hip replacement patients while lowering costs for hospitals.

The proposed rule can be viewed here . CMS said the public has 60 days to submit comments regarding the proposed rule, which was published Tuesday in the Federal Register. 

Latest News

Claims Life Cycle
Thirty-three percent of the American public supports a single-payer system, up from 21 percent in 2014.
Claims Life Cycle
Senate Majority Leader abandons plan to force a vote before the July 4 recess.

Stay Up To Date!

Get the latest revenue cycle insights delivered right to your inbox.