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Date ArticleType
8/1/2016 Payment/Reimbursement
CMS Proposes New Mandatory Cardiac Bundle, Expands CJR and BPCI

On June 25, the Centers for Medicare & Medicaid Services (CMS) issued a lengthy proposed rule aimed at expanding bundled payments in the Medicare program. The new rule, which is over 900 pages long, proposes to do the following:

  • Implement a new, mandatory bundled payment model for heart attack and bypass surgery episodes that will be tested in 98 randomly-selected Metropolitan Statistical Areas (MSAs) across the country (yet to be selected);
  • Expand the current Comprehensive Care for Joint Replacement (CJR) program by adding a hip and femur fracture episode in the 67 MSAs that already have begun testing the model (click here to review AHCA's summary of the CJR final rule);
  • Implement a new incentive payment model around cardiac rehabilitation to be tested in 90 MSAs (45 of which were also selected for the aforementioned cardiac episode model and 45 of which were not); and
  • Establish a pathway for physicians with significant participation in bundled payment models to qualify for payment incentives under the recently proposed Quality Payment Program by adding a new voluntary bundled payment model to the Bundled Payments for Care Improvement (BPCI) initiative, which will be available in 2018.

These policies, if implemented as they are currently proposed, likely would have a significant impact on providers. AHCA staff will be reviewing and analyzing the proposed rule in depth and will release a more detailed summary and analysis of the various proposals. The association will work with the appropriate member committees, workgroups, and constituencies to gather feedback and develop robust comments. Comments on the rule will be due near the end of September.

Please find some additional resources below:

  • Click here for the full proposed rule. 
  • Click here for the CMS press release on the rule. 
  • Click here for the CMS fact sheet on the rule.