Final Rule Details Bundled Payment Models For Cardiac Services The Centers for Medicare and Medicaid Services (CMS) this past December released the “Advancing Care Coordination Through Episode Payment Models” (EPMs) final rule. Specifically, the final rule: • Creates new mandatory EPMs for the Acute Myocardial Infarction (AMI) Model and the CABG Model. • Mandates the first performance period for the new EPMs to begin on July 1, 2017 and run through December 31, 2021, giving eligible clinicians, including physicians and non-physician practitioners, the opportunity to qualify as participating in an Advanced Alternative Payment Model (APM) through EPMs as part of the Quality Payment Program outlined under the Medicare Access and CHIP Reauthorization Act. 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 use 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. “As we move from volume-based care to valuebased care, this new path for cardiologists to participate in Advanced APMs under MACRA’s Quality Payment Program 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. ACC Approved to Provide Part IV Credit The ACC has been approved as a Portfolio Program sponsor of the Multi-Specialty Portfolio Approval Program under the American Board of Medical Specialties (ABMS). As a sponsor, the College can deliver more meaningful and relevant quality and process improvement experiences and award Part IV credit for ABMS maintenance of certification (MOC) to its members with dual board certifications (i.e., pediatrics and thoracic surgery), as well as its growing number of Affiliate members involved in areas like family medicine, radiology and emergency medicine. Additionally, while the American Board of Internal Medicine (ABIM) has suspended Part IV requirements under its MOC program, credit is still granted for practice improvement activities. Those physicians choosing to participate in the MOC program and subsequently Part IV activities will benefit from this new development. On a broader scale, Portfolio Program sponsor designation also positions the College as a trusted source of patient safety, patient voice and practice improvement activities for those members looking to maximize their efforts to meet Quality Payment Program requirements outlined under the Medicare Access and CHIP Reauthorization Act (MACRA). Physicians choosing to participate in the Merit-Based Incentive Payment System (MIPS) option under the Quality Payment Program must take part in improvement activities ranging from offering expanded evening and weekend hours to participating in MOC Part IV. ACC Submits Comments on MACRA Final Rule The ACC submitted formal comments in response to the final Medicare Access and CHIP Reauthorization Act (MACRA) rule released in November. In the comment letter, the College notes its support for the “depth of changes” included in the final rule as a result of public comments. However, the letter cautions that CMS “still has a heavy lift ahead in ensuring that the Quality Payment Program (QPP) is implemented in a way that truly supports improved patient outcomes without distracting clinicians from their priority of treating patients.” The letter highlights several key areas where further improvements are needed in order to achieve this goal, as well as encourages continued clarification and education on how best to implement 2017 QPP policies into practice. Moving forward, the ACC notes that “the continued refinement of the QPP will require ongoing dialogue between CMS and the clinicians, patients, vendors and other stakeholders affected by this program,” particularly as unforeseen issues arise.
Published by American College of Cardiology. View All Articles.
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