CMS Finalizes Bundled Payment Model for Cardiac Care 

Today the Centers for Medicare & Medicaid Services (CMS) released a final rule creating a new, mandatory bundled payment model for heart attack and cardiac bypass surgery services. The cardiac bundled payment model will be mandatory for hospitals located in 98 geographic areas beginning July 1, 2017. CMS also finalizes policies to:

  • Expand the Comprehensive Care for Joint Replacement (CJR) model which began in April of this year to include additional surgical services for hip and femur fractures
  • Create an ACO overlap policy that would exclude from episode payment models, beneficiaries who are aligned to ACOs in the Medicare Shared Savings Program (MSSP) Track 3, Next Generation ACO model and ESRD Seamless Care Organizations in the Comprehensive ESRD Care Initiative in tracks with downside risk for financial losses
  • Allow ACOs to participate as episode payment model collaborators in certain circumstances
  • Establish pathways for physicians who participate in the new cardiac bundles and expanded CJR program to qualify as Advanced Alternative Payment Models under MACRA beginning in 2018
  • Create a cardiac rehabilitation incentive payment model to increase cardiac rehabilitation utilization 

NAACOS continues to have concerns with CMS policies regarding the overlap of ACO and bundled payment initiatives. Though CMS has finalized a limited overlap policy which would exclude beneficiaries aligned to MSSP Track 3 and Next Generation ACOs, these programs will continue to have an impact on ACOs ability to succeed. NAACOS will continue to advocate for more reasonable policies related to bundled payment initiatives that allow for ACOs’ continued success. More information on today’s announcement is available on the CMS website and fact sheet, available here