Introduction, Cancellation, and Future Promise of Medicare Cardiac Episode Payment Models

Payment reform is a tool to improve the quality and consistency of patient care while also reducing unnecessary costs.Cardiovascular disease draws attention for new payment models primarily because it accounts for >$200 billion in annual spending.1 One such model, Advancing Care Coordination through Episode Payment Models (EPM), was an initiative of the Centers for Medicare and Medicaid Services (CMS).These episode payments, also known as bundled payments, were designed to increase coordination, reduce unwarranted variation, and incentivize value-oriented care for patients with coronary artery disease.Providers would have been incentivized with an episode payment linked to specific quality benchmarks.However, after the change in administration in 2017, mandatory EPMs were first delayed and then cancelled.Here, we will focus on the design of the proposal, as well as factors that ultimately prevented implementation.Finally, we will review the future potential for the re-emergence of EPMs. STRUCTURE OF THE PROGRAMOriginally, the EPM structure was to be implemented July 1, 2017, in phases from 2017 to 2021. 2 After the change in administration after the November 2016 election, CMS extended the initiation date of the EPM to January 1, 2018, to allow time to review the policy for modifications.3 In August 2017, CMS proposed a rule to cancel the EPM. 4 Enrollees in the initiative would have been hospitals in 98 metropolitan statistical areas, selected randomly from 293 eligible metropolitan statistical areas.Acute care hospitals within these metropolitan statistical areas would continue to receive fee-for-service payments for services beginning with an initial hospitalization for an acute myocardial infarction or coronary artery bypass surgery and extending 90 Introduction, Cancellation, and Future Promise of Medicare Cardiac Episode Payment Models