CMS Provides BPCI Advanced Guidance on PCI, TAVR and Cardiac Rehab

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The second cohort of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) is scheduled to begin on Jan. 1, 2020. This will mark Model Year 3 of the program, which will introduce a new TAVR episode.

In response to participant feedback, the Centers for Medicare and Medicaid Services (CMS) has issued the following policy changes to the program in order to better support the optimal delivery of cardiovascular care under the model:

PCI Followed by TAVR

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Participants have indicated an increasing prevalence of PCI clinical episodes containing a TAVR procedure in the 90-day post-anchor period. The inclusion of TAVR costs in the PCI clinical episode is impacting a participant's ability to control clinical episode expenditures. To mitigate this concern, precedence rules are modified for this overlapping scenario; if a PCI clinical episode overlaps with a TAVR clinical episode, where the PCI start date is on or before the TAVR start date, the TAVR clinical episode will be retained and the PCI clinical episode will be canceled, regardless of the participation status of the episode initiator associated with these clinical episodes. Additionally, the cost of TAVR inpatient stays will be carved out of PCI clinical episodes to prevent artificially high PCI target prices.

Cardiac Rehabilitation

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CMS stresses the importance of cardiac rehabilitation services to improve long-term cardiovascular outcomes for beneficiaries. Cardiac rehabilitation services are traditionally underutilized and providers may be disincentivized from recommending therapy in the performance period if there was limited uptake during the baseline period. To remove disincentives and encourage providers to prescribe cardiac rehabilitation services to beneficiaries, CMS will carve cardiac rehabilitation/intensive cardiac rehabilitation spending out of clinical episode spending in both the baseline and performance periods. The benefits of removing cardiac rehabilitation costs from all clinical episodes can be two-fold; the potential to improve beneficiary well-being and reduce spending via decreased readmissions in the long-term.

Questions regarding this guidance or other aspects of BPCI Advanced can be sent to

Keywords: ACC Advocacy, Health Expenditures, Cardiac Rehabilitation, Centers for Medicare and Medicaid Services, U.S., Transcatheter Aortic Valve Replacement, Patient Readmission, Medicare, Medicaid, Percutaneous Coronary Intervention

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