On the heels of a successful launch of the Comprehensive Care Joint Replacement (CJR) bundled payment program this past year, CMS is expanding their crusade to reduce cost and enhance care.
On July 25, the agency announced the proposed roll-out of three more episode-based payment programs:
- Expansion of the current CJR model by including also surgical hip & femur fractures;
- Two new bundled payment initiatives for (1) acute myocardial infarction (AMI), and (2) for patients undergoing coronary artery bypass graft (CABG).
Industry experts predict a significant impact on post-acute care providers, especially as these changes relate to the need for a collaborative, cross-continuum approach to managing the cardiovascular patient population.
Based on our experience, HealthPRO®/Heritage views these dramatic changes as opportunity. The savvy post-acute operator who can leverage clinical, operational and strategic excellence will reap the benefits of meaningful partnerships with referral sources. This journey begins with learning more about the proposed bundle payment programs.
5 Facts About the CMS Proposal for Bundled Payment Program for CV Patients
- The CMS proposal for a new bundled payment system was announced last Monday and will include patients treated for acute myocardial infarction (AMI) and those undergoing coronary artery bypass graft surgery (CABG).
- AMI episodes will be triggered by both medical management of AMI (inpatient hospital discharges for MS-DRGs 280-282) and AMI diagnoses treated with percutaneous coronary intervention (PCI) (inpatient hospital discharges for MS-DRGs 246-251)
- CABG episodes will be triggered by inpatient hospital discharges for MS-DRGs 231-236.
- This new mandatory initiative is expected to launch in July 2017. CMS is accepting comments on the proposed mandate thru September 23.
- Ninety-eight participants will be randomly selected from the 294 eligible metropolitan statistical areas (MSAs), making for what will be a significant variation in the types of markets enrolled. (Note: the CJR program selected only 67 MSAs.)
- CMS to introduce a two-tiered reimbursement system emphasizing the importance of cardiac rehab services where CMS will pay $25 per cardiac rehab service for the first 11 services given during the episode, while subsequent services would be reimbursed at $175 per service. (Currently, many patients do not complete cardiac rehab course because of high co-pays, so this proposed system will encourage patient retention and serve to offset costly ancillary costs (e.g.: transportation). This incentive payment model, based on utilization of rehab services in the 90-day window, will serve to test the impact of providing incentive payments to hospitals on patient outcomes in 45 hospitals with the selected 98 MSAs and 45 hospitals in non-MSA markets.
- The CMS site specifically states, “One of the major goals of bundled payments is to encourage coordination among all providers involved in a patient’s care.” As such, it is expected that hospitals will choose “preferred SNF providers” based on critical factors such as:
- Hospital readmissions reduction initiatives;
- Aptitude for better understanding patients’ discharge disposition so as to better align appropriate care/support discharge planning;
- Cost-effective strategies to improve patient adherence to cardiac rehab;
- Star Ratings
- Qualitative measures such as willingness to collaborate, ease of communicating, transparency in sharing performance data, etc.
- Ability to adhere to cross-continuum care pathways that span inpatient, outpatient, and post-acute care settings
- Capacity for comprehensive, cross-continuum training
As CMS continues to unveil these new payment models, industry stakeholders agree: bundled payment models are gaining momentum and are here to stay. In fact, CMS may roll-out new voluntary episodic payment models in 2018, so perhaps SNF operators may consider using the next year to prepare to participate.
Stay tuned for more updates from credible resources, such as HealthPRO®/Heritage, for guidance as the landscape continues to change. In fact, many SNFs may elect to engage forward-thinking, solution-oriented experts, like HealthPRO®/Heritage, who can offer resources, advice and perspective via consulting services in an effort to make strategic, necessary changes to stay relevant in this evolving era of healthcare reform.