By Jonathan Springston, Associate Managing Editor, AHC Media
The Centers for Medicare & Medicaid Services (CMS) issued a proposed a mandatory model this week that could transform how hospitals treat cardiac patients by shifting the focus from quantity of care to quality of care while also rewarding providers for administering preventive care.
It’s the latest proposed expansion of the CMS bundled payment model, whereby hospitals that deliver high-quality care are eligible to receive savings greater than facilities that don’t perform as well, all based on a series of quality and performance measurements.
The U.S. Department of Health and Human Services (HHS) says the reason for expansion is twofold. First, heart attacks and strokes lead to one in three U.S. deaths and more than $300 billion in related costs annually. In 2014, more than 200,000 Medicare beneficiaries experienced a hospital stay for a heart attack or bypass surgery, costing the agency more than $6 billion. Yet, second, the cost of surgery, treatment, and recovery, as well as the percentage of patients readmitted 30 days after initial admission, varied wildly.
“Today’s proposal is an important step to improving the quality of care Americans receive and driving down costs,” said HHS Secretary Sylvia Burwell in a statement. “By focusing on episodes of care and rewarding successful recoveries, bundled payments encourage hospitals to coordinate care to achieve the best outcomes possible for patients.”
An additional part of the proposed CMS model calls for offering incentive payments to hospitals that place patients in rehabilitation, thereby possibly lowering patient risk of heart attack and death.
The comment period is open for this proposed model, a five-year demonstration that would take effect July 1, 2017, in 98 randomly selected metropolitan areas. American Hospital Association Executive Vice President Tom Nickels noted in a statement that this is the third CMS mandatory demonstration project in the last year.
“America’s hospitals are committed to improving care coordination thoughtfully and systematically in order to create better value for our patients and communities," he said. "We will fully analyze the proposals and we look forward to improving them so they are reasonable and workable for patients.”
Days earlier, CMS announced new participants in the Million Hearts Cardiovascular Disease Risk Reduction Model, a system in which healthcare practitioners will assess individual patient risk for heart attack or stroke and apply preventive measurements.
“Our healthcare system historically often emphasized acute care over preventive care,” said Dr. Patrick Conway, CMS acting principal deputy administrator and chief medical officer, in a statement. “This initiative will enhance patient-centered care and give practitioners the resources to invest the time and in staff to address and manage patients who are at high risk for heart attacks and strokes.”
This is all part of a broad national effort, led by CMS, the CDC, and HHS, to prevent 1 million heart attacks by 2017 and tying 30% of Medicare payments to alternative payment models that reward quality care.
The September issue of Hospital Case Management will take feature an in-depth exploration of the bundled payment model concept, including more information about this model as it applies to cardiac care. For more information about the diagnosis and treatment of heart disease, please be sure to check out Clinical Cardiology Alert.