Finally, the rubber hits the road for value-based care: Bundled payment for cardiac surgeries

This summer, another victory was was won for quality-based healthcare payments, moving the healthcare industry toward higher quality, cost-effective care. The Centers for Medicare and Medicaid Services (CMS) expanded its mandatory Bundled Payment Initiative (BPI) to include cardiac care and hip fractures as part of its ongoing effort to restructure the way government reimburses care. Given the unique challenges of treating cardiac patients, this new initiative will test if health systems are ready to handle not just the rhetoric of value-based care, but the actual care delivery demands it will bring.

CMS has been pushing the rhetoric of value-based care for some time. In January 2015, Health and Human Services Secretary Sylvia M. Burwell said that by the end of 2016, 85 percent of Medicare payments would be tied to quality, and the number would increase to 90 percent by 2018. She also said by the end of 2016, 30 percent of Medicare payments would be tied to quality/value via alternative payment models such as ACOs or bundled payment models, and by the end of 2018, 50 percent would. Earlier this year, CMS announced the components of the Medicare-Incentive Based Payment System (MIPS), the new model for physician services component of care payments, would be tied to quality starting in reporting year 2017.

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Apixio, BPI, Bundled Payment Initiative, Centers for Medicare and Medicaid Services, CMS, Medicare Shared Savings Program, Medicare-Incentive Based Payment System, MIPS, Sylvia M. Burwell


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