Federal health regulators have proposed test a new way to pay hospitals that treat Medicare beneficiaries for heart attack, bypass surgery and hip fractures to control costs and improve patient outcomes.
Hospitals would be paid on a "bundled" basis for treating such patients. The new model would effectively give the hospitals a lump-sum payment from Medicare for the care. If the hospital kept the costs lower than what it was being paid by Medicare, it would be able to bank the savings.
‘The new bundled payment model will increase the number of people who undergo cardiac rehabilitation, control costs and improve patient outcomes.’
The US Health and Human Services Department said it was proposing a new model to increase the number of people who undergo cardiac rehabilitation. Studies have shown that cardiac rehab lowers the risk of another heart attack or death. But only 15% of heart attack patients now undergo cardiac rehab.
The new bundled payment model is to push the health-care system toward medical providers being paid fees for overall health outcomes, as opposed to the current predominant system whether providers are paid separately for every procedure or test they perform.
"Having a heart attack or undergoing heart surgery is scary and stressful for patients and their families," said HHS Secretary Sylvia Burwell.
"Today's proposal is an important step to improving the quality of care Americans receive and driving down costs. By focusing on episodes of care and rewarding successful recoveries, bundled payments encourage hospitals to coordinate care to achieve the best outcomes possible for patients."
Dr. Patrick Conway, acting principal deputy administrator of the federal Centers for Medicare and Medicaid Services, a division of HHS, said, "The current way that Medicare pays for cardiac care by hospitals has led to variations in cost and quality of care at different hospitals."
More than 200,000 Medicare beneficiaries were in hospitals in 2014 for either heart attack treatment or bypass surgery, costing Medicare more than $6 billion.
The bundled-payment model for cardiac care would be phased in over a period of five years. It would start next year from July 1,2017 for hospitals in 98 metropolitan areas.
"Under the new models in today's rules, the hospital in which a Medicare patient is admitted for care for a heart attack or bypass surgery would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries during the in-patient stay and for 90 days after discharge," HHS said.
The new payment model for hip fractures would be phased in starting with the 67 metro areas whose 800 hospitals are already receiving bundled Medicare payments for hip replacements.