Friday, May 19, 2017 Cardiac Bundling Program, CJR Expansion, Won't Happen Until January 2018 The introduction of a mandatory Medicare bundling program for cardiac care that had been delayed until October has now been pushed back further to January 2018, according to a final rule by the Centers for Medicare and Medicaid Services (CMS). That delay also applies to plans to expand the comprehensive joint replacement model (CJR) already in place. The final rule requires 98 randomly selected metropolitan areas to participate in bundling programs for care associated with bypass surgery and heart attacks under Medicare parts A and B, and includes provisions that will incentivize the use of cardiac rehabilitation. It also includes an expansion of the CJR model beyond hip and knee arthroplasty, to include patients undergoing care for hip and femur fractures. However, these changes will not be implemented before January of next year. CMS says the delay “will ensure that CMS has adequate time to undertake notice and comment rulemaking, if modifications are warranted.” APTA has developed a fact sheet on the rule, and CMS offers general information and presentation slides on the topic, plus an overview of what it calls "episodic payment models." APTA's education efforts on bundling began well before the April 1, 2016, startup of CJR and include 2 webinars (1 on the basics of the CJR program and 1 that includes insights from PTs participating in bundled care programs), an article in PT in Motion magazine, and a webpage that contains background information as well as links to evidence-based clinical information and community programs.