CMS Eliminates Cardiac Payment Model Programs, Relaxes Joint Replacement Care Models

The Centers for Medicare and Medicaid Services (CMS) announced this week that it is eliminating two new payment models entirely, the Episode Payment Model and the Cardiac Rehabilitation incentive payment model, and easing requirements for the Comprehensive Care for Joint Replacement (CJR) model. The Episode Payment Model and the Cardiac Rehabilitation model were scheduled to begin on January 1, 2018.

The changes, which were announced as part of a proposed rule, would scale back the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation Center’s CJR model from 67 to 34.

In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis, CMS said in a press release. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

“Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” said CMS Administrator Seema Verma in a statement. “Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries.”

According to Modern Healthcare, up to 470 hospitals are expected to continue using the CJR model, including CMS’ estimate that 60 to 80 hospitals would choose to voluntarily participate. If no changes had been announced this week, Modern Healthcare estimates that 800 acute care hospitals would have participated in the program.

“With so many hospitals getting an out, the CMS estimates the model will save $90 million less over the next three years versus what it would have saved had no changes been made. The model is now expected to save $204 million over those years instead of $294 million,” Modern Healthcare reported.

Additionally, the publication estimated that the cardiac bundled payment programs would have saved Medicare $159 million over five years.

Public comments to this proposed rule will be accepted until October 16, 2017 at 11:59 p.m.

Click here for more information on the Comprehensive Joint Replacement model, and click here for more information on the Episode Payment Models and for the Cardiac Rehabilitative model.

Mary Butler is the associate editor at The Journal of AHIMA.

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