BUSINESS CONSULT
DEIRDRE BAGGOT, RN, PHD
Principal, ECG Management Consultants
TORI MANIS
Senior Manager, ECG Management Consultants
CMS Targets Cardiovascular
Care With New Mandatory
Bundles
I
n the June issue of CardioSource WorldNews,
Deirdre Baggot, PhD, discussed how bullish the Centers for Medicare and Medicaid
Services (CMS) is on bundled payments. At the
time, Dr. Baggot stated that the expansion of
existing bundled payment programs and creation
of the mandatory Comprehensive Care for Joint
Replacement (CJR) program clearly communicate
CMS’s belief in bundles – and that cardiac-specific
bundles were likely on deck.
Last month, CMS confirmed that prediction
by announcing three new bundles, called episode
payment models (EPMs), for acute myocardial
infarction (AMI), coronary artery bypass graft
(CABG), and hip/femur fractures. Additionally, a
new program for increasing cardiac rehabilitation
was also proposed.
The AMI and CABG bundles present new
challenges and opportunities for cardiologists and
cardiac surgeons. The model, as it is currently
described in the proposed rule, will hold hospitals
financially accountable for the cost and quality of
medical and surgical care for the two events during
inpatient stays and for 90 days following discharge.
The proposed 5-year demonstration will go into
effect on July 1, 2017. CMS identified 294 MSAs
that will be eligible, 98 of which will be mandated
to participate (MSA’s are expected to be named by
year’s end).
We talked to Dr.
Baggot, Principal, and
Tori Manis, Senior
Manager, with ECG
Management Consultants’ Bundled Payments practice, about
the program and what
organizations can do
to prepare for cardiac
bundles.
Why did CMS select
cardiovascular care for
inclusion in its second
set of mandatory
bundles?
Conditions and procedures such as AMI and
CABG are high-volume and high-cost for Medicare.
They also tend to have fairly high readmission rates,
which CMS especially wants to curb. For an AMI
episode, there is an average 20% readmission rate,
which accounts for half of the estimated costs. For
CABG, approximately 75% of costs are hospitalbased, with the majority of the post-discharge costs
being related to readmissions. So, CMS clearly sees
an opportunity here to reduce costs and improve
outcomes.
“Improving communication between
the ER and surgeons, physicians, and
clinical team members who are going
to be taking care of these patients is
essential—again, care coordination.”
ACC.org/CSWN
CMS’s first mandatory bundled payment
program focused on orthopedic procedures.
How are cardiac bundles different from CJR?
With CJR, most joint replacements are elective and planned weeks ahead of time, enabling
providers to predict and often avoid or minimize
clinical variation. There’s sound evidence that
elective procedure bundles can standardize care
and save money. But bundling heart attack care
is a very different exercise. Heart attacks are
unpredictable, require immediate treatment, and
are followed by high readmission rates. The effectiveness of bundles for emergent episodes has
not been tested and needs more study. Adding
emergent procedures is a testing ground for CMS,
and it will be interesting to follow the clinical and
financial results.
The AMI bundle would seem to pose particular
challenges, given the unpredictability and high
readmission rates for heart attacks. How can
organizations prepare?
Certainly, there needs to be emphasis on care
coordination and post-discharge follow-up. Care
transitions during the post-acute period need to be
CardioSource WorldNews
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