The Centers for Medicare and Medicaid Services (CMS) today issued a proposed rule canceling its episode payment models (EPMs) and the cardiac rehabilitation incentive model, which were slated to start on Jan. 1, 2018. The agency also made significant changes to its joint replacement payment model, reducing the number of mandatory geographic areas participating and allowing participation in the remaining areas to be voluntary.

"Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals," said CMS Administrator Seema Verma. "Stakeholders have asked for more input on the design of these models. These changes make this possible and give CMS maximum flexibility to test other episode-based models that will bring about innovation and provide better care for Medicare beneficiaries."

CMS had selected 1,120 hospitals to participate in the EPMs for acute myocardial infarction (AMI) (triggered by admissions for AMI and admissions representing percutaneous coronary intervention treatment for AMI) and coronary artery bypass (CABG) for acute care hospitals. Additionally, 1,320 hospitals had been selected to participate in the Cardiac Rehabilitation Incentive Payment Model, which would have allowed for a retrospective payment based on total cardiac rehab use of beneficiaries attributable to participant hospitals.

Cancellation of the program will impact eligible clinicians, including physicians and non-physician practitioners, who were planning to use participation in the EPMs to qualify as participating in Advanced Alternative Payment Models (APMs) outlined under the Quality Payment Program, particularly in this first year. ACC Advocacy staff and leaders are reviewing the update now and more information on the impacts to cardiovascular clinicians and next steps will be posted to ACC.org and included in the Advocate.

Moving forward, CMS notes plans to increase opportunities for providers to participate in voluntary initiatives rather than large mandatory episode payment model efforts.

"The ACC will continue to work with CMS on opportunities for clinicians to participate meaningfully in Advanced APMs," said ACC President Mary Norine Walsh, MD, FACC. "As we move from volume-based care to value-based care, the path forward is challenging and we must work together to find solutions."

Keywords: Centers for Medicare and Medicaid Services, U.S., Cardiac Rehabilitation, Medicaid, Medicare, Physicians

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