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  • CMS Expands Mandatory Bundling Program to Cardiac Care, Including Rehab

    The Centers for Medicare and Medicaid Services (CMS) has announced the latest in its move toward value-based payment systems—this time through the introduction of a mandatory bundling program for care associated with bypass surgery and heart attacks, including provisions that would incentivize the use of cardiac rehabilitation.

    The demonstration plan announced by CMS would affect hospitals in 98 randomly selected metropolitan areas and would work much like the Comprehensive Care for Joint Replacement (CJR) model implemented this year. Similar to CJR, the new bundling plan would reimburse providers a set amount for an entire episode of care, from admission to 90 days after the patient is discharged. Medicare would create targets for spending, and if the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare. If hospitals spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference. And like CJR, the cardiac bundling plan is mandatory for hospitals in those areas.

    Also included in the cardiac demonstration proposed rule: a proposal to extend the CJR bundling provisions beyond hip and knee arthroplasty to include patients undergoing care for hip and femur fractures. The project would launch July 1, 2017, and last for 5 years.

    "Just like CJR, the model is mandatory and extends to metropolitan statistical areas [MSAs] that include the 67 areas already covered in CJR," said Roshunda Drummond-Dye, APTA director of regulatory affairs. "If PTs want to formally collaborate with hospitals to share in incentive payments, they must negotiate contractually. But the bottom line is, if they are included in one of the identified MSAs and they treat patients within 90 days from discharge from the hospitals after a heart attack, bypass, or hip surgery, the care they provide will count toward the bundle."

    The cardiac program also includes an initiative that would promote the use of cardiac rehabilitation during the 90-day period after discharge. According to a fact sheet from CMS, the initial payment would be $25 per cardiac rehab service for each of the first 11 services paid for by Medicare. After 11 services are paid for by Medicare for a beneficiary, the payment would increase to $175 per service. "Clinical studies have found completing a rehabilitation program can lower a patient’s risk of heart attack or death," CMS writes. "Increasing the use of cardiac rehabilitation services has the potential to improve patient outcomes and help keep patients healthy and out of the hospital."

    Drummond-Dye says that the expanding use of bundling programs is part of a larger shift toward value-based payment models—and something PTs need to be tuned into.

    "One key proposal that uniquely affects PTs is the provision to make CJR and other bundled payment models qualify as alternative payment models under [the Medicare Access and CHIP Reauthorization Act, or MACRA]," Drummond-Dye said. "At first glance, this is good news for our providers, as this gives them more opportunities to participate in alternative payment models and quality programs under MACRA—it's something that APTA advocated for in our comments, and, essentially, CMS listened."

    Meanwhile, APTA advises that PTs stay on top of patient data and evidence to make the bundling models work for them.

    "It is imperative that PTs know the composition of the patient population they treat and have clinical evidence on the outcomes of their care for this patient population," Drummond-Dye said.

     APTA intends to provide comments on the cardiac bundling demonstration by the September 24 deadline, and continues to track implementation of CJR.

    The APTA CJR webpage contains extensive information on both the nuts-and-bolts of the program and the considerations physical therapists should weigh when making practice decisions. The online resource also includes links to evidence-based clinical information and community programs, as well as a free webinar on the system.


    • Interesting, PT has always been a worthwhile contender to provide cardiac rehab. The bundled care idea makes life easier for Medicare to control spending. The burden is once again placed on the providers to prove that every patient case is different and why patient A needs more service than patient B. I hope that the APTA realizes how there support for the value based payments could potential destroy indidvidually own private practices like mine with supporting this move of CMS and providing no legal support for small providers like myself to "negotiate contracts with hospitals regarding payments and incentive pay" other than the comment....PT need tone on top of this.... I will be excited to create more overhead spending by hiring an attorney and negotiating rates with hospitals....that is like negating with insurance companies....a big joke! Thanks APTA for supporting another item that will benefit large PT operations that have a team of attorneys at their beckon call to tie up contracts with hospitals to create another "referral monopoly" while turning a blind eye to the unethical practices that these large corporations do to their treating PTs, a billing quota, seeing more than one patient at a time, allow large open gyms to blur the lines for individualized care....all by the way are Medicare guidelines for skilled care. It is unfortunate to see how the profession is now using all the new research in our field that helps to justify what we do and use it to cut off our face despite our nose. I have been in this profession for almost 20 years, I love this profession, it is sad to see the return of chain clinics ugly reminders of Healthgoingsouth, nocare, and the other corporate giants killing patient one on one care, pushing the PTs to bill beyond their ethics while threatening their job if they don't comply.....ugly schene during 1998-2000's.

      Posted by James Trout on 8/16/2016 8:47 AM

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