Heart of Health Policy

CMS Proposes Cancellation of Episode Payment Models, ICD Registry a Model for Quality Improvement and More.

CMS Proposes Cancellation of Episode Payment Models, Cardiac Rehab Incentive Model

The Centers for Medicare and Medicaid Services (CMS) last month 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. Read More >>>

“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 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.

Cardiology Magazine Image"As we move from volume-based care to value-based care, the path forward is challenging and we must work together to find solutions." Mary Norine Walsh, MD, FACC

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.”

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ICD Registry a Model for Quality Improvement

The ACC’s ICD Registry, one of the College’s 10 NCDR registries, “has been a model of professional transparency, accountability, and science in exchange for expanded payment for devices” since its creation as a means for hospitals to meet the Centers for Medicare and Medicaid Services (CMS) requirement that patients receiving ICDs for primary prevention be enrolled in either an approved clinical trial or in a national registry, write Frederick M. Masoudi, MD, FACC, and William J. Oetgen, MD, FACC, in a recent leadership page published in the Journal of the American College of Cardiology. Read More >>>

To date, more than 1.7 million ICD implantations have been recorded in the ICD Registry, and more than 75 peer-reviewed scientific papers using ICD Registry data have been published. “These studies have advanced our understanding of device selection, care, and outcomes nationally, addressing key questions of the effectiveness, safety, equity, and efficiency of care,” note Masoudi and Oetgen. “These studies have exponentially increased the value of the ICD Registry data well beyond the specific issues outlined in the original CED; their validity has been substantially enhanced with the availability of a true national denominator of patients receiving this therapy.”

With CMS re-evaluating the registry mandate, Masoudi and Oetgen stress that the benefits of the registry must be considered. “Given that the indications for ICD therapy will change with this update, patients, physicians and policymakers will need valid contemporary data to ensure the optimal use of these devices and to achieve better outcomes,” they write.

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Million Hearts Celebrates Success, Sets New Goals for 2022

Between 2012 and 2016 the Million Hearts program brought together 120 official partners (including the ACC), 20 federal agencies, and all 50 states and the District of Columbia around the shared goal of preventing one million deaths from cardiovascular disease over a five-year period. In its recently published “Meaningful Progress 2012-2016: A Final Report,” early data shows that the novel public/private initiative has helped prevent an estimated half a million cardiovascular events, while also making significant headway in reducing cardiovascular risk factors like smoking and hypertension. Read More >>>

Co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS), Million Hearts is focused on keeping people healthy and optimizing quality care through its ABCS approach: Aspirin when appropriate, Blood pressure control, Cholesterol management and Smoking cessation.

Among the patient-focused goals, Million Hearts saw substantial reductions in its initial five years in tobacco use, improving cardiovascular health for millions, including those experiencing secondhand smoke. In fact, the initiative estimates it will surpass its target (reduce tobacco use by 23.6 percent) by the end of 2017. Among the health care system-focused goals, CMS Electronic Health Record (EHR) Incentive Programs helped identify half a million patients with hypertension through a 53 percent increase in EHR use in outpatient care between 2011 and 2015 (from 34 percent to 87 percent).

The Million Hearts report also highlights two specific programs for notable achievements over the past five years: Million Hearts Hypertension Control Challenge and Million Hearts Cardiovascular Disease Risk Reduction Model. The competition recognized 59 doctors, health care practices and health systems, including ACC members and medical groups reporting via the CMS Group Practice Reporting Option, for achieving blood pressure control rates at or above 70 percent for more than 13.8 million patients.

Meanwhile, 516 organizations across 47 states, the District of Columbia and Puerto Rico now use the Risk Reduction Model, which tests how financial incentives impact the identification and management of risk for cardiovascular disease among eligible Medicare beneficiaries. To assist practices participating in the Risk Reduction Model, the ACC partnered with CMS and the American Heart Association (AHA) on a risk assessment tool to help predict the 10-year risk of developing atherosclerotic cardiovascular disease (ASCVD). The Million Hearts Model Longitudinal ASCVD Risk Assessment tool launched in November 2016 as an extension of the ASCVD Pooled Cohort Equation, which was first published in the 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk.

“Progress was clearly made in improving CV care and health by more than 120 partners, including ACC and its members, during the first five-year phase of Million Hearts. However, the pace of improvement is far too slow and the cumulative effect of decades of obesity, physical inactivity and diabetes threatens further progress in cardiovascular disease prevention,” states Janet Wright, MD, FACC, executive director of Million Hearts.

For example, while the Million Hearts Hypertension Control Challenge demonstrates that the initiative’s target blood pressure control target is achievable, overall blood pressure control has only increased by 4.3 percent between 2009-2010 and 2015-2016 (53.4 percent vs. 57.7 percent) across the U.S.

Looking ahead, Million Hearts 2022 will continue to improve its ABCS approach, focusing primarily on decreasing sodium intake, while increasing physical activity. New efforts for Million Hearts 2022 will focus on prioritizing improvement outcomes for highly affected populations, particularly African-Americans and Hispanics between the ages of 35 and 64.

“With a strong foundation of powerful private and public sector partners, Million Hearts 2022 is designed to accelerate the implementation of strategies that work to prevent cardiovascular disease and improve heart and brain health. We look forward to working with the College and all members of the cardiovascular team to get to at least a million by 2022,” says Wright.

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ACC Comments on Proposed Medicare Physician Fee Schedule

The ACC this month submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2018 Medicare Physician Fee Schedule and related policies included in the proposed rule.

The ACC’s comment letter specifically addresses proposed changes to the new appropriate use criteria (AUC) requirement for advanced imaging services (i.e., SPECT MPI, CT and MR), as well as changes to malpractice and practice expense components of the fee schedule, and recommendations regarding work relative value units for specific codes, payment rates for services provided by off-campus provider-based departments, quality and value program adjustments and reporting, and patient relationship codes to be used in quality reporting. The comments also touch on the implementation of new patient relationship codes aimed at improving cost measurement attribution.

Read the comments on ACC.org. The final Medicare Physician Fee Schedule is expected later this fall.

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Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Lipid Metabolism, Nonstatins, Interventions and Imaging, Computed Tomography, Nuclear Imaging, Exercise, Hypertension, Smoking

Keywords: ACC Publications, Cardiology Magazine, Tobacco Smoke Pollution, Smoking, Smoking Cessation, Sodium, Aspirin, Cardiovascular Diseases, Blood Pressure, African Americans, Cardiac Rehabilitation, Quality Improvement, Retrospective Studies, Risk Factors, Medicare, Centers for Medicare and Medicaid Services (U.S.), Hypertension, Primary Prevention, Risk Assessment, Registries, Diabetes Mellitus, Myocardial Infarction, Coronary Artery Bypass, Obesity, Cholesterol, Percutaneous Coronary Intervention, Fee Schedules, Hispanic Americans, Risk Reduction Behavior, Tomography, Emission-Computed, Single-Photon, Electronic Health Records, Centers for Disease Control and Prevention (U.S.), Life Style, Ambulatory Care, Group Practice, Malpractice, Social Responsibility, Arthroplasty, Replacement, Exercise, Tomography, X-Ray Computed

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