CMS finalizes new episode models and adjusts CJR model

CMS recently released the Advancing Care Coordination through Episode Payment Models final rule, which makes adjustments to the Comprehensive Care for Joint Replacement (CJR) Model and introduces new Innovation Center modules intended to support CMS’ shift from quantity to quality in healthcare.

The models are aimed at helping providers deliver quality care at a lower cost while rewarding hospitals for avoiding patient complications, preventing readmissions, and accelerate recovery time.

The final rule includes three new payment models focused on improving cardiac care, including the Acute Myocardial Infarction (AMI) Model, the Coronary Artery Bypass Graft (CABG) Model, and the Cardiac Rehabilitation Incentive Model. The rule also introduced the Surgical Hip and Femur Fracture Treatment (SHFFT) Model. Select acute care hospitals in 98 geographic areas will participate in retrospective episode-based payments for the AMI, CABG, and SHFFT models. The performance period for all four models begins July 1, 2017, and ends December 31, 2021.

The final rule made changes to the CJR model by qualifying it as an Advanced APM under the Quality Payment Program and aligning its policies with episode payment models (i.e., AMI, CABG, SHFFT), which hold hospitals financially responsible for the cost and quality of an episode of care thereby incentivizing hospitals to better coordinate care.

CMS will establish quality-adjusted target prices for each episode payment model hospital to include all related services for Medicare Severity-Diagnosis Related Groups included in the CJR, AMI, CABG, and SHFFT models. AMI, CABG, and SHFFT model hospitals will also receive a composite quality score based on past care provided. For the Cardiac Rehabilitation Incentive Model, providers will be paid under the usual Medicare rules, but may receive an additional incentive payment at the end of a performance year.