Itís Official: Cardiac Bundles and ACO Final Rule Announced

News | Published: Wednesday, December 21, 2016 9:00 am

by MedAxiom


Yesterday the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models that continue to shift Medicare payments from rewarding volume to rewarding value by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models will reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.


The announcement finalizes significant new policies related to:

Cardiac care - Three new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery.

Orthopedic care - One new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement. In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.

Accountable Care Organization opportunity for small practices - The new Medicare ACO Track 1+ Model will have more limited downside risk than Tracks 2 or 3 of the Medicare Shared Savings Program in order to encourage more practices, especially small practices, to advance to performance-based risk.

These new payment models and the updated Comprehensive Care for Joint Replacement Model give clinicians additional opportunities to qualify for a 5 percent incentive payment through the Advanced Alternative Payment Model (APM) path under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. For the new cardiac and orthopedic payment models, clinicians may potentially earn the incentive payment beginning in performance year 2019 or potentially as early as performance year 2018 if they collaborate with participant hospitals that choose the Advanced APM path.

The models will be referred to as:

  • Acute Myocardial Infarction (AMI) Model;
  • Coronary Artery Bypass Graft (CABG) Model;
  • Surgical Hip and Femur Fracture Treatment (SHFFT) Model; and
  • Cardiac Rehabilitation (CR) Incentive Payment Model.

The AMI and CABG Models will be implemented in 98 geographic areas, defined by MSAs. MSAs are counties associated with a core urban area that has a population of at least 50,000. Are you in one of the 98 MSAs? Click here to find out.


For an overview of the Final Rule announcement click here.



Stay tuned as MedAxiom offers details, insight and analysis of the final rule. MedAxiom’s team of Bundled Payment and APM experts will provide you with the information, tools and resources that bring clarity and help you create a plan to comply with and benefit from these new initiatives.


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