Expanding Payment Reform in Medicare

Abstract

Cardiovascular disease is the leading cause of death and disability in the United States, accounting for 1 in 4 deaths and more than $200 billion in direct and indirect costs annually. 1 In July 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a new episode-based payment model for myocardial infarction. This model aims to improve the quality and efficiency of cardiac care and helps move the United States toward CMS's goal of having 50% of traditional Medicare payments in valuebased models by 2018.Proposed to launch July 1, 2017, the cardiac payment model would provide hospitals with an episodebased payment covering the index hospitalization for acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery and care paid under Medicare Parts A or B for 90 days after discharge. 2 Hospitals will bear financial risk or receive rewards based on episode-level spending and quality-similar to "2-sided" population-based global payment contracts that reward accountable care organizations if spending is below budget and penalize them if spending exceeds the budget. Specifically, in the cardiac model, if spending is less than the episode-based amount, hospitals may keep a portion or all of the difference, provided they meet

Impact of Intensity-Modulated Radiotherapy on Health Care Costs of Patients With Anal Squamous Cell Carcinoma

“…Many episode-based payment models are structured around a time period only a few weeks to months after treatment to encompass acute and subacute treatment-related complications. 24–26 The Centers for Medicare and Medicaid Services Oncology Care Model is the latest iteration of a specialty-based global payment system that encompasses a 6-month period of care after the initiation of chemotherapy. 27 However, our study suggests that this approach may be insufficient for radiotherapy-centric episodes because cost savings as a result of decreased toxicity from more advanced radiation techniques may require a longer time period to be observed.…”

Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival

“…[53][54][55] More than 600,000 deaths (1 in 4) are attributable to heart disease each year, and CVD accounts for more than $70 billion annually (approximately 17% of the total health care expenditure). [56][57][58] By the year 2030, 40% of the US population is projected to have some form of CVD, and care will exceed $800 billion, making it our most costly disease. 56 The understanding of the pathogenesis of atherosclerosis has recently undergone a dramatic update.…”

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 more than $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).…”

“…This may have measurable effects on hospitals with different case mixes, such as referral centers for STEMI. The resulting adverse incentives may lead to risk-averse behavior by hospitals, with selection bias influencing treatment decisions within participating hospitals 1 . Predictive cost analysis models have demonstrated that hospitals that care for sicker patients with fewer financial means may perform worse in this payment model 13 .…”