Bundled Payments for Cardiac Procedures Are Next, Says CMS

August 12, 2016 | Aging Services Risk, Quality, & Safety Guidance

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​The Centers for Medicare and Medicaid Services (CMS) proposed on July 25, 2016, a mandatory program that would make hospitals in 98 randomly selected metropolitan areas financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks. All related care within 90 days of hospital discharge will be included in the episode of care. Hospitalizations for heart attacks cost Medicare more than $6 billion in 2014, according to a July 25, 2016, article in Modern Healthcare, but the cost varies by as much as 50% from treatment to treatment. As with joint-replacement payment bundles, CMS would set target prices for cardiac surgery based on historical regional data and hospital-specific data. Hospitals that beat the target while also maintaining quality benchmarks would get to keep the savings. Those that exceeded it would have to pay Medicare back at the end of the year. The calculation would rely mostly on hospital-specific data in the first two years and then only on regional data in the final two years.

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