Provider-based Impact Deep Dive:
As part of a drive toward innovation, the Centers for Medicare & Medicaid Services (CMS) continues to roll out episode-based payment initiatives focused on improving cardiac and orthopedic care.
These programs include the current Comprehensive Care for Joint Replacement (CJR) model and proposed:
- 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
This intelligence along with a patient’s clinical history are mapped within the machine’s Eigen-based architecture to pin point the interventions that will drive the highest levels of engagement for each individual patient. With this propensity information, clinicians can better align clinical actions and resources to the patients who are most likely to benefit and engage with specific care activities and interventions.
These models all share common goals aimed at enabling collaboration, communication, and prevention; and improving the quality and efficiency of care for Medicare patients. The distinct feature of episode-based payments is the incentive to deliver better care at a lower cost from the time a patient is admitted through 90 days post-discharge.
The carrots and sticks that are core to the program have helped to deliver significant savings across participating providers. In a recent study published in JAMA Internal Medicine, covered episodes under the current CJR saw a decrease of $5,577 or 20.8%. New bundles, which are scheduled to go live in July 2017, will extend the current program to include patients admitted for heart attacks, bypass surgery, and/or cardiac rehabilitation following a heart attack or heart surgery. The CJR program will be replaced by the SHFFT model, which extends the covered treatments to include patients who receive surgery after a hip fracture.