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CMS Expands Medicare Bundled Payment Models
January 6, 2017—The Centers for Medicare and Medicaid Services (CMS) Dec. 20 released a final rule implementing three new Episode Payment Models (EPMs), a Cardiac Rehabilitation Incentive Payment Model, and modifies the Comprehensive Care for Joint Replacement Model to streamline it with EPM regulations.
The EPMs are designed to incentivize providers to deliver higher quality cardiac and orthopedic care at a lower cost. EPMs begin on July 1 and end on Dec. 31, 2021, and participation in EPMs is mandatory for hospitals located in select Metropolitan Statistical Areas (MSAs).
In order to protect certain vulnerable providers from excessive losses, CMS is instituting lower stop loss limits for Medicare dependent hospitals, rural referral centers, sole community hospitals and certain low-volume hospitals.
The Cardiac Rehab (CR) Incentive Payment Model will also begin on July 1 and end on Dec. 31, 2021. The CR Incentive Payment Model will be implemented in 90 MSAs, and providers in these MSAs will receive $25 per CR service for the first 11 services, and $175 per service thereafter.
The final rule also finalizes the proposal to allow Comprehensive Care for Joint Replacement Model (CJR) to qualify as an advanced APM under the MACRA Quality Payment Program. If the participant hospital attests to Certified Electronic Health Record Technology (CEHRT) use and submits a notice to CMS, it can qualify as an Advanced APM.
Selected hospitals must meet or exceed performance thresholds on quality metrics in each of the three models in order to be eligible for reconciliation payments. These quality measures include CABG and AMI mortality, HCAHPS, AMI excess days in acute care, and hip/knee complications.
For more information about the AAMC’S efforts to support EPM, CR, and CJR participants can email firstname.lastname@example.org.
Scott Wetzel, M.P.P.
Lead, Quality Reporting
Jessica Walradt, M.S.
Senior Payment Reform Specialist
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