New CMS payment models affect cardiologists, hospitals throughout U.S.

Starting this year, a large number of cardiologists treating fee-for-service Medicare patients will participate in programs in which their reimbursement is tied to providing value-based care. It is the continuation of a trend that many leaders in the healthcare industry believe will become the norm.

CMS announced three new payment models pertaining to acute MIs, CABG and cardiac rehabilitation on Dec. 20, 2016. The goals of the programs are to reward hospitals in which providers collaborate to deliver quality care, reduce costs and prevent readmissions.

The initiatives are part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. Clinicians can earn incentive payments of up to 5 percent if they collaborate with hospitals as early as performance year 2018.

The models are scheduled to begin on July 1 run through 2021. Many in the cardiology community are taking a “wait and see” approach and are eager to see how the initiatives are rolled out later this year.

“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.”

The models are extensions of an initiative that CMS launched in 2015. At the time, the agency said it wanted to have 30 percent of Medicare payments through alternative payment models by the end of 2016. CMS reached that goal by March 2016.

The acute MI and CABG models will be implemented in 98 geographic areas, which each have a population of at least 50,000 residents. The cardiac rehabilitation incentive payment model will be implemented in 45 geographic areas that were selected for the acute MI and CABG models and 45 geographic areas that were not selected for those tow models.

Approximately 1,120 hospitals will participate in the acute MI and CABG models and 1,320 hospitals will participate in the cardiac rehabilitation model. For each model, hospitals will be financially accountable for the quality and cost of an episode of care, according to CMS.

CMS announced the proposed payment models last July and asked for comments. Based on that feedback, the agency made some changes, including implementing downside risk for the acute MI and CABG models, adopting a voluntary quality measure for the CABG model and establishing an Alternative Payment Models Beneficiary ombudsman to monitor the models and field inquiries from beneficiaries.

CMS said that clinicians participating in the models would have access to webinars, fact sheets and open door forums to learn more about the initiatives and understand how they can succeed in the new environment.

“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,” Department of Health and Human Services Secretary Sylvia M. Burwell said in a news release. “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.”