Cardiology episodes

Bundled payment episodes involving cardiology cases

What Specialists Should Consider in Bundled Payment Participation

by Jonathan Pearce, CPA, FHFMA and Darcie Hurteau

Risks and Opportunities in Medicare’s Cardiac Bundled Payment Program

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Jonathan W. Pearce, CPA, FHFMA

Introduction

In July 2016 CMS released a Notice of Proposed Rulemaking (NPRM) of its intent to implement a mandatory bundled payment program for specified cardiology and cardiac surgery services, along with several other programs. These Episode Payment Models (EPMs) will begin in July 2017 for almost all hospitals located in 98 selected metropolitan statistical areas (MSAs).

Combining Clinically-Similar Bundled Payment Episodes to Reduce Risk and Improve Care

Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH

The Medicare Bundled Payment for Care Improvement (BPCI) program allows participants to assume financial risk for all Medicare services occurring within 30 to 90 day period after hospital discharge. Model 2 participants give up 2% of the episode target amount as a discount to CMS in 90-day episodes, but are allowed to retain any savings from Medicare cost reductions below the target amounts.

Why Some DRGs May Never Be Appropriate for Bundling

 Initially some BPCI participants were intrigued with the idea of participating in limited, procedurally-based episodes such as percutaneous coronary interventions (PCI) episodes in the Medicare Bundled Payment for Care Improvement program.

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