Health Law Daily Final rule puts quality at the heart of new Medicare payment models
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Wednesday, December 21, 2016

Final rule puts quality at the heart of new Medicare payment models

By Bryant Storm, J.D.

New Medicare Parts A and B payment models announced by HHS, under an advance release of a Final rule, include: a cardiac rehabilitation (CR) incentive payment model; a model which will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement; and a new Medicare accountable care organization (ACO) model focused on small organizations. The Final rule is set to be published in the Federal Register on January 3, 2017, and the regulations are effective February 18, 2017.

Incentive payments. The models provide clinicians with additional opportunities to qualify for a 5 percent incentive payment through the Advanced Alternative Payment Model (APM) path created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10) and the Quality Payment Program. The new payment structures are designed to further HHS’ goals of shifting health care from quantity based payment models to payment models based upon the quality of care.

APMs. The new APMs include three episode payment models (EPMs) for episodes of care surrounding an acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT). HHS chose the AMI, CABG, and SHFFT models because the agency believes those EPMs will allow hospitals to engage in effective care redesign, by:

  • increasing post-hospitalization follow-up and medical management for patients;
  • coordinating across the inpatient and post-acute care spectrum;
  • conducting appropriate discharge planning;
  • improving adherence to treatment or drug regimens;
  • reducing readmissions and complications during the post-discharge period;
  • managing chronic diseases and conditions that may be related to the EPMs' episodes;
  • choosing the most appropriate post-acute care setting; and
  • coordinating between providers and suppliers such as hospitals, physicians, and post-acute care providers.

The EMPs will be tested for five years, with the first performance year beginning July 1, 2017.

Other models. The Final rule also establishes the new Medicare ACO Track 1+ Model, which is designed to limit downside risk, in the hopes of encouraging additional practices, especially small practices, to move towards performance-based risk models. Under the new model, an estimated 70,000 clinicians will be able to qualify for Advanced Alternative Payment Model (APM) incentive payments in 2018. HHS is also finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016. HHS will continue testing the CJR model for 5 performance years, ending December 31, 2020.

MainStory: TopStory AgencyNews GCNNews ReimbursementNews IPPSNews CMSNews PaymentNews PartANews PartBNews ProviderNews

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