CMS finalizes new payment models for acute MI, CABG, cardiac rehabilitation

The Centers for Medicare & Medicaid Services (CMS) finalized three new payment models to improve cardiac care, reduce preventable readmissions and decrease costs.

The models, which were announced on Dec. 20, pertained to acute MIs, CABG and cardiac rehabilitation. CMS originally proposed the models on July 25 and took comments into consideration when publishing the final rules.

Acute care hospitals in several geographic areas will participate in the models beginning on July 1, 2017, and ending Dec. 31, 2021.

For the acute MI and CABG models, approximately 1,120 hospitals in 98 geographic areas will be financially accountable for the quality and cost of an episode of care beginning with a hospitalization and extending for 90 days following hospital discharge.

CMS plans on establishing quality-adjusted target prices for each hospital that treats eligible Medicare fee-for-service beneficiaries. Providers and suppliers will continue to be paid until the established payment system, but at the end of the year, CMS will compare the actual spending with the aggregate quality-adjusted target price for each hospital. Hospitals could receive additional payments from Medicare or repay Medicare depending on their performance.

Providers and suppliers will also continue to be paid as usual under the cardiac rehabilitation incentive payment model. At the end of the year, participating hospitals could receive additional payments if they utilization cardiac rehabilitation services.

CMS plans on implementing the cardiac rehabilitation incentive payment model in 45 geographic areas that are selected for the acute MI and CABG models as well as in 45 geographic areas that are not selected for those models.

Under the cardiac rehabilitation incentive payment model, participating hospitals will receive $25 per cardiac rehabilitation service for each of the first 11 services paid for by Medicare during the care period for an acute MI or CABG care episode and $175 per service during care period after 11 services.

"As we move from volume-based care to value-based care, this new path for cardiologists to participate in Advanced Alternative Payment models under MACRA’s Quality Payment Program is a challenging step,” American College of Cardiology president Richard Chazal, MD, said in a news release. “It is our sincere hope that the end result will be opportunities for coordinated care and improvement in quality, while also decreasing costs for patients with heart attack or who undergo bypass surgery.”