On Jan. 22, the Government Accountability Office (GAO) released a report titled Voluntary and Mandatory Episode-Based Payment Models and Their Participants. Using an analysis of CMS data, evaluation reports and interviews with stakeholders, including ACC members and staff, the GAO identified the characteristics of model participants and the benefits of using either voluntary or mandatory participants for episode-based payment models. The ACC was interviewed specifically on the Episode Payment Models for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG) that were subsequently cancelled.

As of the writing of the report, the Centers for Medicare and Medicaid Services (CMS) had tested, or was in the process of testing, six episode-based payment models: Bundled Payments for Care Improvement Models 1 through 4, Comprehensive Care for Joint Replacement and the Oncology Care Model. The report describes the characteristics of the providers that participated in six tested episode-based payment models and compares the relative advantages of voluntary versus mandatory episode-based payment models.

The report noted that providers participating in these models typically had more beds or larger practices, had higher episode volume and were more often located in urban areas compared to all providers that did not participate. Stakeholders commented that voluntary participation allows participants to select the models they have identified as being the best fit. Stakeholders also shared the advantage that mandatory participation allows Medicare to test with a more diverse participant group.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Medicare, Medicaid, Coronary Artery Bypass, Health Expenditures, Myocardial Infarction

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