In an attempt to encourage coordinated care, improve the quality of care and decrease costs for heart attack patients, the Centers for Medicare and Medicaid Services (CMS) released the final rule for Advancing Care Coordination Through Episode Payment Models (EPMs); the Cardiac Rehabilitation Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model on Dec. 20 that finalize bundled payment models for certain cardiac conditions and procedures in select geographic areas. The final regulation introduces a new cardiac rehabilitation (rehab) model and a pathway that helps physicians who are heavily involved in bundled payment models to qualify for incentives as part of the Advanced Alternative Payment Model (APM) track beginning in performance year 2019, as part of the downside risk parameters under the Quality Payment Program (QPP), part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Specifically, the Advancing Care Coordination Through Episode Payment Models final rule:

• Creates new mandatory EPMs for the Acute Myocardial Infarction (AMI) Model and the Coronary Artery Bypass Graft (CABG) Model.
• Mandates the first performance period for the new episode payment models will begin on July 1, 2017 with the duration through December 31, 2021, which gives eligible clinicians, including physicians and non-physician practitioners, the opportunity to qualify as participating in Advanced APMs through EPMs as part of the QPP. Importantly, these EPMs are one of a select few Advanced APM options for specialists and the only option specifically for cardiologists.
• Introduces a cardiac rehab incentive payment to increase utilization of cardiac rehab services for heart attack and bypass surgery Medicare beneficiaries referred to as the Cardiac Rehab Incentive Payment Model with the same duration as the EPMs.

The AMI and CABG Models will be implemented in 98 geographic areas defined as MSA (counties associated with a core urban area that has a population of at least 50,000). Eligible MSAs must have at least 75 AMI Model eligible cases among other criteria. Participant hospitals in the selected areas include all acute care hospitals participating in the Inpatient Prospective Payment System that are not currently participating in Models 2, 3 or 4 of the Bundled Payment for Care Improvement initiative for AMI or CABG episodes. The Cardiac Rehab Incentive Payment Model will be implemented in 45 geographic areas selected for the AMI and CABG models (MSAs) along with 45 geographic areas not selected for those models.

The release of the final rule is a concrete step toward accomplishing the Department of Health and Human Services' goal of having 50 percent of Medicare payments tied to APMs by the end of 2018. Currently, more than 30 percent of Medicare Part A and B payments are tied to APMs.

"As we move from volume-based care to value-based care, this new path for cardiologists to participate in Advanced APMs under MACRA’s QPP is a challenging step,” said ACC President Richard A. Chazal, MD, FACC. "It is our sincere hope that the end result will be opportunities for coordinated care and improvement in quality, while also decreasing costs for patients with heart attack or who undergo bypass surgery.”

In October, the ACC submitted comments to CMS in response to the proposed rule. The College’s comments focused on clinical and operational design providing special attention to the AMI model as a primary diagnosis, as well as recommendations on quality measures selected. Stay tuned to ACC.org for more information as ACC Advocacy takes a deeper dive into the final rule in the coming weeks.

Keywords: Arthroplasty, Replacement, Centers for Medicare and Medicaid Services, U.S., Coronary Artery Bypass, Inpatients, Medicaid, Medicare, Medicare Part A, Myocardial Infarction, Prospective Payment System, Quality of Health Care, Medicare Access and CHIP Reauthorization Act of 2015