CMS Officially Cancels EPM and Cardiac Rehab Incentive Payment Models

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule officially canceling the Episode Payment Models (EPMs) for AMI and CABG and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinding the regulations establishing these models, effective Jan. 1, 2018.

In releasing the final rule, CMS stressed that "value-based payment methodologies will play an essential role in lowering costs and improving quality of care, which will be necessary in order to maintain Medicare's fiscal solvency" and reiterated its commitment to developing value-based models that would allow for Advanced APM participation in 2018 and beyond. "We believe that focusing on the development of different bundled payment models and engaging more providers in these models is the best way to drive health system change while minimizing provider burden and maintaining patient access to care," the Agency stated.

Specifically, CMS acknowledged the comments it received on the proposed cancellation rule and noted agreement "with the premise cited by commenters that the CR Incentive Payment Model could provide an opportunity to collect evidence and may support provision of an under-utilized yet effective intervention." However, the Agency went on to say: "Due to the manner in which the regulations guiding the cardiac EPMs were interwoven with those of the CR Incentive Payment Model, we do not believe it would be feasible to continue the mandatory CR Incentive Payment Model alone at this time since we are cancelling the EPMs and rescinding all of the associated regulations. However, as we stated in the proposed rule, as we further develop the Innovation Center's portfolio of models, we may revisit the concept of a model with a focus on cardiac rehabilitation and, if we do, will consider stakeholder feedback."

The ACC's comments were among the 85 received by CMS. The College will continue to work with CMS to develop further opportunities for the cardiology community to participate in APM models. In a separate comment letter to CMS on the future direction of the Center for Medicare and Medicaid Innovation (CMMI), the College outlined support for increasing participation in APMs, physician specialty models and expanding the mandate of the Physician-Focused Payment Model Technical Advisory Committee to include APMs for Medicaid and CHIP. The letter also supports models that give flexibility in cost sharing for high value services, such as cardiac rehabilitation.

Keywords: Medicaid, Centers for Medicare and Medicaid Services (U.S.), Cardiac Rehabilitation, Motivation, Advisory Committees, Solvents, Medicare, Cost Sharing, Health Expenditures, Drive, Quality of Health Care, ACC Advocacy, Medicare Access and CHIP Reauthorization Act of 2015

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