by Jonathan Pearce, CPA, FHFMA and Darcie Hurteau
Bundled payment episodes involving cardiology cases
Jonathan W. Pearce, CPA, FHFMA
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).
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.
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.