CMS finalizes MACRA alternative payment models
The Centers for Medicare & Medicaid Services on Dec. 20 unveiled a new final rule it said would offer a simpler path for physicians to join alternative payment models to satisfy the requirements of the Medicare Access and CHIP Reauthorization Act of 2015.
But the new models for cardiac and orthopedic care could get push-back from incoming Health and Human Services Secretary Tom Price, whose signature is prominent on a September 2016 letter, signed by more 170 members of Congress, voicing opposition to the CMS Innovation Center for implementing mandatory bundled payment models without first testing them in a small area.
Hospitals in the metro areas chosen for the models will take part in the new models, CMS said.
The cardiac models will apply to hospitals located in the 98 metro areas, which equals about one-quarter of all metro areas in the nation.
The surgical hip fracture treatment model will apply to hospitals in 67 metro areas, which are the same metro areas currently included in the comprehensive care for joint replacement model.
The new models will operate over a period of five years beginning July 1, 2017.
Asked about CMMI's efforts being overturned in a new administration once President-elect Donald Trump takes office, Patrick Conway, MD, acting principal deputy administrator for CMS, said efforts such as MACRA have received bipartisan support.
The rule also establishes a provision for smaller and rural practices to join an accountable care organization.
The approach provides the opportunity for an estimated 70,000 clinicians to qualify for advanced alternative payment model incentive payments in 2018, CMS said.
To encourage more practices and especially small practices to advance to performance-based risk, the new Medicare ACO Track 1+ Model will have more limited downside risk than in Tracks 2 or 3 of the Medicare Shared Savings Program, CMS announced.
For physicians and smaller hospitals, the level of risk is 8 percent of revenue, according to CMS. For larger hospitals, the benchmark is 4 4 percent.
CMS's Innovation Center is broadening the funnel so more physicians can participate in MACRA alternative payment models, according to CMS Acting Administrator Andy Slavitt.
"We simplified the rule and reduced the number of things physicians have to comply with," Slavitt said.
In addition, CMS has finalized the comprehensive care for joint replacement model.
The cardiac model will support clinicians in three models providing care for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation.
The second new payment model will support clinicians in providing care in surgery after a hip fracture beyond hip replacement.
One in three deaths is caused by heart attacks and strokes, CMS said.
In 2014, more than 200,000 Medicare beneficiaries were hospitalized for heart attack treatment or underwent bypass surgery, costing Medicare over $6 billion.
But the cost of treating patients for bypass surgery, hospitalization, and recovery varied by 50 percent across hospitals, and the share of heart attack patients readmitted to the hospital within 30 days varied by more than 50 percent.
In addition, only 15 percent of heart attack patients receive cardiac rehabilitation, even though clinical studies have found that completing a rehabilitation program can lower the risk of a second heart attack or death.
"As a practicing doctor, I know the importance of hospitals, doctors, nurses and others working together to support a patient from heart attack or surgery all the way through recovery. These bundled payment models support coordinated care and can reward clinicians through the Quality Payment Program," Conway said.
"The new ACO Track 1+ was developed based on heavy stakeholder input and will enable many more physician practices to progress to an advanced model that receives incentive payments. The model allows doctors and other clinicians to practice the way they want to – working with patients to redesign care and provide the best outcomes possible."
Under the new approaches, the hospital in which a Medicare patient is admitted for care for a heart attack, bypass surgery, or a hip or femur procedure will be accountable for the quality and cost of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge.
The cardiac rehabilitation incentive payment model will test the impact of providing payment to hospitals to incentivize referral and coordination of cardiac rehabilitation following discharge from the hospital for a heart attack or bypass surgery.
These payments will cover the same five-year period as the cardiac care bundled payment models. They will be available to hospital participants in 45 geographic areas that were not selected for the cardiac care bundled payment models, and 45 geographic areas that were selected for the cardiac care bundled payment models.
CMS plans to offer education and training to support and prepare clinicians in these models. These activities will include webinars about each model as well as qualification criteria for the quality payment program incentive payments, fact sheets explaining what model participants will need to do to be successful in the models, and open door forums where CMS staff will be able to answer questions about the models.
These new approaches help shift Medicare payments to create incentives for hospitals and clinicians to work together to avoid complications, avoid preventable hospital readmissions, and speed patient recovery.
Slavitt said this would probably be the last time before he leaves office, that he was able to say thank you to the CMS Innovation Center.
This story first appeared in Healthcare Finance.