CMS: New payment models impact cardiologists and hospitals

In 2017, a huge number of cardiologists treating fee-for-service Medicare sufferers will participate in programs in which their reimbursement is tied to giving value-based care. It is the continuation of a trend that several leaders in the healthcare industry believe will become the norm.

3 new payment models have been declared by CMS pertaining to acute MIs, CABG and cardiac rehabilitation on the day of Dec. 20, 2016. The programs’ goals are to reward hospitals in which providers collaborate to deliver quality care, decrease costs and stop readmissions.
The proposed initiatives are key part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. Incentive payments of up to 5% can be earned by clinicians if they collaborate with hospitals as early as performance year 2018.
The new payment models are scheduled to start on the day of July 1 run through 2021. Many in the cardiology community are implementing a “wait and see” approach and are willing to see how the initiatives are rolled out later this year.
American College of Cardiology president Richard Chazal, MD, stated in a news release, “As we shift from volume-based care to value-based care, this latest path for cardiologists to participate in Advanced Alternative Payment models under MACRA’s Quality Payment Program is a challenging initiative. It is our sincere expectation that the end result will be chances for coordinated care and improvement in quality, while also reducing charges for sufferers with heart attack or who undergo bypass surgery.”
These models are the extensions of an initiative that CMS started in the year of 2015. At the time, the organization stated that it needed to have 30% of Medicare payments through alternative payment models by the end of 2016. By the March 2016, CMS reached that aim.
In 98 geographic areas, the acute MI and CABG models will be implemented which each have a population of nearly 50,000 residents. In 45 geographic areas, the cardiac rehabilitation incentive payment model will be implemented that were opted for the acute MI and CABG models and 45 geographic areas that weren’t chosen for those two models.
In the acute MI and CABG models, almost 1,120 hospitals will participate and 1,320 hospitals will engage in the cardiac rehabilitation model. Hospitals will be financially accountable for the quality and cost of an episode of care for each model, in accordance to CMS.
In last July, CMS declared the proposed payment models and asked for comments. The agency made few changes base on that feedback, involving implementing downside risk for the acute MI and CABG models, adopting a voluntary quality measure for the CABG model and developing an Alternative Payment Models Beneficiary ombudsman to monitor the models and field inquiries from beneficiaries.
In accordance to CMS, clinicians participating in the models would have access to webinars, fact sheets and open door forums to learn more about the initiatives and comprehend how they can succeed in the new atmosphere.
Department of Health and Human Services Secretary Sylvia M. Burwell claimed in a news release, “Today, we are honored to continue progress strengthening Medicare for beneficiaries, providers, and taxpayers with alternative payment models that reward the quality of care over quantity of services. These models provide providers and hospitals the tools they require providing the kind of high-quality patient-centered care we all need for our own families, while also driving down charges for the nation.”