On December 20th, 2016, CMS finalized the proposed rule for the expansion of mandatory bundled payments for heart attacks and coronary bypass surgeries to begin on July 1, 2017. In 2014 there were more than 200,000 heart attack hospitalizations, costing Medicare over $6B. When the agency looked at claims data across the episodes, the costs varied by as much as 50% across providers. For many, it is no surprise that AMI and CABG were selected as the next mandatory bundles.
What do cardiac bundles entail?
This proposed model also builds on this year’s Comprehensive Care for Joint Replacement (CJR) model by adding Surgical Hip and Femur Fracture Treatment (SHFFT) patients. This year’s CJR model was the first ever mandatory bundled payment model putting hospitals in certain geographic areas at risk for cost and quality of care beginning with the day of admission to 90 days post discharge. Like CJR, the bundled payment target price for the cardiac models will transition from hospital-specific data in the initial two years to regional data only in the last two years.
Despite more or less following the blueprint for the CJR program, one unique attribute of the cardiac program is the Cardiac Rehab (CR) Incentive Payment model, which provides financial incentives for cardiac rehab, a historically underutilized resource for Medicare patients. Though rehab has been shown to reduce the risk of a second heart attack, only ~15% of attached patients have sought such care following a related episode.
While the hip and femur fracture expansion of CJR will apply to the same 67 Metropolitan Statistical Areas (MSAs) and approximately 800 hospitals as the CJR model, the new cardiac bundle will be tied to 98 identified MSAs, amounting to roughly 1,120 hospitals.
While there is speculation and uncertainty around what the Trump administration will mean for mandatory bundles like the orthopedic and cardiac bundles, there is bipartisan support for the shift to value-based care which promotes quality over quantity. I have been in multiple meetings just this past week with CJR hospitals, and these providers are optimistic about the early cost and quality results that they are seeing under CJR. They plan to replicate the care redesign programs put in place by CJR across other DRG groupings and service lines, regardless of what CMS mandates.
When providers are put at risk for extensive episodes of care, like the 90+ day CJR and cardiac bundles, it forces them to consider new and innovative ways to stay better engaged with patients throughout their entire episode of care. It also encourages them to think about better cross-functional care team coordination and communication. Click here to see the many ways that providers leverage CipherHealth solutions to support their bundled payment programs and drive better outcomes at a lower overall episode cost.