Home care providers that can maintain high-quality care while reducing Medicare spending have new opportunities to position themselves as key collaborators in a new mandatory Medicare episode payment model (EPM) for cardiac rehabilitation as well as an expansion to the existing Comprehensive Care for Joint Replacement (CJR) model.
On December 20, 2016, the Centers for Medicare & Medicaid Services released a 1,600-page Medicare final rule that implements a new EPM centered on cardiac rehabilitation. This model is specific for these hospital Medicare Severity-Diagnosis Related Groups (MS-DRGs):
- Acute myocardial infarction (AMI): MS-DRGs 280-282
- Percutaneous coronary intervention: MS-DRGs 246-251 (if an AMI diagnosis code is billed in the principal or secondary position on the claim)
- Coronary artery bypass graft (CABG): MS-DRGs 231-236
Like the existing CJR model, this new EPM holds hospitals financially accountable for all related Medicare spending under Medicare Parts A and B for 90 days after the inpatient discharge date for each of these MS-DRGs.
Medicare also is implementing a unique cardiac rehabilitation (CR) incentive payment model to improve patient outcomes following an AMI or CABG in select metropolitan statistical areas (MSAs). In addition, hospitals currently subject to the CJR model will have three additional MS-DRGs (480-482) for surgical hip and femur fracture treatment (SHFFT) added to their responsibilities. All MSAs subject to the EPM are listed here.
Home care providers play a pivotal role in post-acute care by offering a collaborative care option to hospitals that historically resulted in less Medicare spending than inpatient care options and has proven highly successful at managing inpatient readmissions that result in high costs and penalties to hospitals. Home care agencies that can demonstrate high quality and reduced Medicare spending are well positioned to be preferred collaborators with hospitals subject to EPMs. An estimated 1,120 hospitals will participate in the AMI and CABG models, 860 in SHFFT and 1,320 in CR. The overarching goal for EPMs is to improve quality of care while decreasing Medicare spending through increased financial accountability.
BKD’s home care advanced payment models website offers insights and tools for home care providers seeking assistance in navigating the emerging landscape of EPMs and other advanced payment models.
For questions or assistance, contact your BKD advisor.