In December, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) implementing new and revised episode payment models (EPMs) developed by the CMS Innovation Center.  The Final Rule continues CMS’ transition of Medicare payment methodologies away from fee-for-service and towards value-based payments, including by incentivizing care coordination efforts and tying payments to quality improvement.

New EPMs:  The Final Rule implements three new EPMs for episodes of care surrounding (i) acute myocardial infarction (AMI); (ii) coronary artery bypass graft (CABG); and (iii) surgical hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT). Each episode of care encompasses a beneficiary’s inpatient stay as well as all related care within 90 days after discharge covered under Medicare Parts A and B. The initial performance year for the EPMs will start July 1 and expire December 31, 2017, and be followed by four successive performance years (2018-2021). Participation in the AMI and CABG EPMs will mandatory for acute care hospitals located in 98 randomly-selected metropolitan statistical areas (MSAs), and participation in the SHFFT EPM will be mandatory for hospitals in the 67 MSAs that currently participate in CMS’s comprehensive care for joint replacement model (CJR Model). The EPMs are designed to incorporate downside risk starting in 2019, but allow participants to assume downside risk in 2018 in order to qualify for potential incentive payments under the Medicare Access and CHIP Reauthorization Act (MACRA), by participating in an Advanced Alternative Payment Model.
Continue Reading CMS Final Rule on Episode Payment Models and Revisions to CJR Model