HHS Releases Regulations on Alternative Pay Models in Last Weeks of Current Administration

Despite Republicans’ call for a suspension on new rules, the Department of Health and Human Services (HHS) pushed regulations regarding Medicare and Medicaid alternative pay models and insurance exchange stability out the door in the final weeks of the Obama administration. It is likely that the administration wanted to put final touches on changes to demonstrations, which test pay and delivery reforms in Medicare and Medicaid. However, the next administration might undo some of the biggest demonstrations for which the Centers for Medicare & Medicaid Services (CMS) published rules in December because they apply to policies most Republicans oppose.
Alternative Payment Models
CMS in December published regulations on mandatory bundled-pay demonstrations for cardiac and joint-replacement services and announced a demonstration that pays bonuses to accountable care organizations for reducing Medicaid spending on beneficiaries enrolled in both Medicare and Medicaid.
The new APMs include three episode payment models (EPMs) for episodes of care surrounding an acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT). HHS chose the AMI, CABG, and SHFFT models because the agency believes those EPMs will allow hospitals to engage in effective care redesign, by:

increasing post-hospitalization follow-up and medical management for patients;
coordinating across the inpati...

Source: Policy and Medicine - January 10, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs