On Jan. 3, the Centers for Medicare & Medical Services (CMS) issued a final rule implementing three new episode payment models (EPMs) under Medicare Parts A and B, and a cardiac rehabilitation (CR) incentive payment model. Previously, under the traditional fee-for-service (FFS) model, Medicare made payments to health care providers for items and services provided over the course of treatment, which primarily incentivizes volume rather than quality. The new EPMs will reward health care providers that work together to avoid complications, prevent hospital re-admissions and promote quick recovery for patients. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare FFS beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care remuneration.
The final rule addresses three care coordination models:
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