CMS unveils bundled payment expansion for cardiac health, joint replacements

The Centers for Medicare & Medicaid Services doubled down on its commitment to alternative payment models this week with the announcement of a new bundled payment program for cardiac care.

The mandatory program, announced Monday, would make hospitals responsible for the cost and quality of all care for patients with heart attacks or bypass surgery. Similar to the agency's Comprehensive Care for Joint Replacement model, each episode of care would include services required within 90 days of hospital discharge.

The cardiac care payment pilot would begin on July 1, 2017, in 98 geographical markets.

The agency also proposed an expansion of the Comprehensive Care for Joint Replacement model, which kicked off in April, to include episodes of care relating to surgeries for hip and femur fractures.

Ushering in the new cardiac care model — the third mandatory pilot from CMS in slightly over a year — before evaluating the CCJR model results may spell trouble for the agency, said Tom Nickels, executive vice president of government relations and public policy for the American Hospital Association.

“CMS is putting the success of these critical programs at risk,” Nickels said in a statement. “Hospitals are under a tremendous burden to help ensure these complex models work for patients.”

CMS' proposal also included a call for comments on how post-acute care providers may be incentivized to make investments in health IT, since certain health technologies “may be critical for certain care management and quality strategies.”

Experts forecasted that skilled nursing facilities would feel pressure as the CCJR was rolled out to be high quality, low cost referral partners for hospitals in pilot areas.

“Limitations in the availability of health IT may pose a barrier to effective post-acute care provider collaboration and sharing of financial risk in episode payment models even when hospitals are the financially responsible entities under such models,” CMS said.