CMS publishes proposed AMI/CABG, CJR rules

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The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule to create a new mandatory bundled payment model for acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) using 90-day episodes of care. The model would apply to 98 randomly selected market areas. SDAHO will issue a brief of the proposed rule, and will analyze the impact on South Dakota member hospitals.

In the same publication, CMS also announced a model to test the effects of payments that encourage the use of cardiac rehabilitation services. These payments would be available to hospital participants in 45 geographic areas that were not selected for the cardiac care bundled payment models, as well as 45 geographic areas that were selected for the cardiac care bundled payment models.

The proposed rule would also expand the existing mandatory Comprehensive Care for Joint Replacement (CJR) bundled payment model to additionally cover surgical hip/femur fracture treatment. CMS proposes to test these bundled payments in the same 67 MSA that were selected for that model. SDAHO will also analyze the proposed addition of these additional hip/femur surgical DRGs.

The proposal also establishes certain conditions by which bundled payment models can qualify as Advanced Alternative Payment Models (APMs) under Medicare’s new physician Quality Payment Program (QPP).

In the interim, a CMS Fact Sheet and the proposed rule are available online. The AHA’s Special Bulletin can be found here.