Under the Wire: CMS Plan to Bundle Cardiac Care Payments Gets 175 Comments

At first, the US government’s plan to bundle Medicare payments related to MI care and bypass surgery was met with what seemed like lukewarm curiosity. But now it seems the muted reaction could be blamed on procrastination. Fully 175 responses—among them a detailed letter by the American College of Cardiology (ACC)—made it into the Federal Register before the close of public comment on October 3.

The proposal was announced by the Department of Health & Human Services in July and, as reported by TCTMD, only eight individuals had commented by late September.

In addition to the ACC, the full list of respondents includes other cardiology-related professional groups such as the Society of Thoracic Surgeons, Heart Rhythm Society, American Heart Association, and Society for Cardiovascular Angiography and Interventions. Closely related subspecialties such as the American Geriatrics Society, American Telemedicine Association, and American Association of Nurse Practitioners also weighed in. Other comments were lodged by healthcare-focused nonprofits and advocacy groups, hospitals, practicing physicians, and industry.

Common themes were the need for risk adjustment in determining payment and assessing quality; questions about how to handle patients transferred for acute MI; further discussion on what constitutes an “episode” of care; and the role of nonphysician clinicians in the new model.

Now, it’s time for the Centers for Medicare & Medicaid Services (CMS) to consider how much these concerns should inform the final rule. While no specific timeline is provided, last year’s rule for bundling payments in joint replacement at acute care hospitals was finalized 11 weeks after the closure of the comment period. According to CMS, the plan would be phased in over a period of 5 years, starting in 98 randomly chosen metro areas as of July 2017.