Newest Bundled Payment Initiative from CMS for Post-Acute Providers
LeadingAge NY has reported on numerous bundled payment opportunities, and this is the newest opportunity with hospitals, home care, skilled nursing facilities, and other post-acute providers. The proposed episodic payment model (EPM) could mean closer hospital and home health coordination for patients with certain heart conditions, as well as those recovering from hip and femur fractures.
The Centers for Medicare & Medicaid Services (CMS) will test in an EPM whether it will reduce Medicare expenditures while maintaining or enhancing the quality of care for Medicare beneficiaries. They believe the proposed EPM will benefit Medicare patients by improving the coordination and transition of care, improving the coordination of items and services paid for through FFS Medicare, and encouraging more provider investment in infrastructure and redesigned care processes for higher quality and more efficient service delivery. CMS will test the EPM for five performance years, July 2017 through December 2021.
According to the proposed rule, hospitals in 98 randomly-selected metropolitan areas would be mandated to take part in the cardiac care bundles. Those hospitals would be responsible for managing a complete 90-day care episode for patients who have acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery. The EPM would also include surgical hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT).
For home care providers, this means that hospitals would be able to contract with home health and other providers to share in the potential savings. Home health agencies that can demonstrate their expertise with this patient population would have a significant advantage in being selected as a partner in this new payment model.
Also, CMS is proposing to loosen some of the strict Medicare requirements for home health services (see page 52 and 482). For instance, some beneficiaries who otherwise would be ineligible for home health services would be allowed up to 13 home visits for an AMI diagnosis or 9 visits during a CABG episode, according to the proposed rule. However, CMS is not proposing to waive the homebound requirement under the proposed EPM.
The official version was published in the Federal Register on Tues. Aug. 2nd, and CMS will accept comments on it for 60 days.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871