Tuesday, December 20, 2016
Today, the Department of Health & Human Services finalized new Medicare alternative payment models that continue the Administration’s progress in reforming how the health care system pays for care. These new approaches will shift Medicare payments from rewarding quantity to rewarding quality by creating incentives for hospitals and clinicians to work together to avoid complications, avoid preventable hospital readmissions, and speed patient recovery.
Today’s announcement finalizes new policies that:
“Today, we’re proud to continue progress strengthening Medicare for beneficiaries, providers, and taxpayers with alternative payment models that reward the quality of care over quantity of services,” said HHS Secretary Sylvia M. Burwell. “These models give providers and hospitals the tools they need to provide the kind of high-quality patient-centered care we all want for our own families, while also driving down costs for the nation.”
Improving Patient Outcomes through Cardiac and Orthopedic Care Coordination
The cardiac and orthopedic episode payment models being finalized today provide opportunities to improve care coordination and quality. The focus of these approaches is to reduce unnecessary variation in care, improve patient results, and reduce preventable readmissions. In 2014, more than 200,000 Medicare beneficiaries were hospitalized for heart attack treatment or underwent bypass surgery, costing Medicare over $6 billion. But the cost of treating patients for bypass surgery, hospitalization, and recovery varied by 50 percent across hospitals, and the share of heart attack patients readmitted to the hospital within 30 days varied by more than 50 percent. In addition, only 15 percent of heart attack patients receive cardiac rehabilitation, even though clinical studies have found that completing a rehabilitation program can lower the risk of a second heart attack or death.
“As a practicing doctor, I know the importance of hospitals, doctors, nurses and others working together to support a patient from heart attack or surgery all the way through recovery. These bundled payment models support coordinated care and can reward clinicians through the Quality Payment Program,” said Patrick Conway, M.D., CMS acting principal deputy administrator. “The new ACO Track 1+ was developed based on heavy stakeholder input and will enable many more physician practices to progress to an advanced model that receives incentive payments. The model allows doctors and other clinicians to practice the way they want to – working with patients to redesign care and provide the best outcomes possible.”
Under the new approaches, the hospital in which a Medicare patient is admitted for care for a heart attack, bypass surgery, or a hip or femur procedure will be accountable for the quality and cost of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge. The new models will operate over a period of five years beginning July 1, 2017. The cardiac models will apply to hospitals located in the 98 metro areas participating in the model (about one-quarter of all metro areas in the nation). The surgical hip fracture treatment model will apply to hospitals in 67 metro areas, which are the same metro areas currently included in the Comprehensive Care for Joint Replacement Model.
The cardiac rehabilitation incentive payment model will test the impact of providing payment to hospitals to incentivize referral and coordination of cardiac rehabilitation following discharge from the hospital for a heart attack or bypass surgery. These payments will cover the same five-year period as the cardiac care bundled payment models and will be available to hospital participants in 45 geographic areas that were not selected for the cardiac care bundled payment models, and 45 geographic areas that were selected for the cardiac care bundled payment models.
Under all of these approaches, beneficiaries retain their freedom to choose services and their hospital or physician. CMS will monitor and evaluate the impact of the approaches on care quality and value. An ombudsman will also be monitoring the models and be available for beneficiaries. More information about the structure of these models is available in the fact sheet.
Continual Feedback and Support for Participating Clinicians
CMS plans to offer education and training to support and prepare clinicians in these models. These activities will include webinars about each model as well as qualification criteria for the Quality Payment Program incentive payments, fact sheets explaining what model participants will need to do to be successful in the models, and open door forums where CMS staff will be able to answer questions about the models.
With the Affordable Care Act, HHS gained new tools to build a health care system that works better for everyone, put individuals at the center of their own care and unlock access to health care data for patients and their clinicians. Doctors, patients, and health care experts across the country support these models because they have seen firsthand their potential for delivering better and more cost-effective care. Stakeholder input is vital for the success of these models, and HHS welcomes feedback on today’s announcement at firstname.lastname@example.org.
The final rule can be viewed at: https://downloads.cms.gov/files/cmmi/epm-finalrule.pdf
For more information on the models, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-12-20.html