US Government Proposes Fixed Payments for ‘Total Experience’ of MI Care, CABG

The US Department of Health & Human Services (HHS) announced yesterday its proposal to bundle Medicare payments for MI care and bypass surgery.

“By structuring payment around a patient’s total experience of care, in and out of the hospital, bundled payments support better care coordination and ultimately better outcomes for patients,” an HHS press release asserts.

Under the new plan, hospitals would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries in these categories both during the inpatient stay and for 90 days after discharge. Participating hospitals would be paid per “care episode,” and those delivering higher-quality care would be paid at a higher rate. Hospitals that find ways to deliver the care for less than the quality-adjusted target price, “while meeting or exceeding quality standards,” will be paid for the savings achieved, whereas hospitals that exceed the target price would be required to pay back Medicare for the cost overruns.

The plan would be phased in over a period of 5 years, starting first in 98 randomly chosen metro areas as of July 2017. These regions amount to around one-quarter of all metro areas in the United States, according to the HHS.

Praising the overall idea of “value-based care,” American College of Cardiology (ACC) President Richard A. Chazal, MD, said in a prepared statement that the Centers for Medicare & Medicaid Services (CMS) “is moving in the right direction by proposing tracks under these new models that may qualify as Advanced Alternative Payment Models under MACRA—providing new ways for specialists to be rewarded for delivering quality care.”

Yet he offered some caveats. “While we support the concept, it is important that bundled care models be carried out in such a way that clinicians are given the time and tools to truly impact patient care in the best ways possible,” Chazal added. “Changes in payment structures in health care can pose significant challenges to clinicians and must be driven by clinical practices that improve patient outcomes. We are optimistic that CMS will listen to comments, incorporate feedback from clinicians, and provide ample time for implementation of these new payment models. Our ultimate goal is to improve patient care and to improve heart health.”

Other aspects of the plan include financial rewards for physicians who participate in bundled payment and incentives for increasing the use of cardiac rehabilitation.

American Heart Association (AHA) President Steven Houser, PhD, also praised value-based payment models, noting that they “may be a way to incentivize high-quality, evidence-based care for patients.”

When it comes to cardiac rehab, the evidence of benefit “could not be clearer,” he stressed, citing the potential to reduce future events and hospital readmissions while improving quality of life. The positive reinforcement included the new plan “could be a significant step in the right direction to overcome this challenge by incentivizing providers to coordinate [cardiac rehabilitation] and ensuring that eligible patients have access to, participate in and adhere to evidence-based [rehab] treatment plans.”

Representatives of both the ACC and the AHA said their groups were in the midst of reviewing the 906-page document, which is expected to soon be open to public comment.

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