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Cardiovascular Rounds

News, resources, and analysis from the Cardiovascular Roundtable

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The three Medicare device payment change proposals you need to know

By Erin Lane August 31, 2015

Last month CMS released the calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, which outlines payment and quality reporting changes for services performed in hospital outpatient departments for the upcoming year. While CMS's decision to uphold the two midnight rule and their continued transition away from fee-for-service captured attention, there are also several important updates regarding payment for medical devices. Given the device-intensive nature of CV services, it’s important for CV leaders to understand these changes to ensure proper payment going forward.  

Below, we review three key proposed modifications that would impact how devices are coded—and reimbursed—going forward.

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What the 2016 PFS proposed rule means for CV providers

by Erin Lane August 26, 2015

Last month CMS released its proposed ruling for the calendar year (CY) 2016 Physician Fee Schedule (PFS), which governs payment policy for independent physician practices, professional payments, and select other health care services.

This year’s proposed rule is somewhat unique in that CMS needed to incorporate elements of newly passed legislation, including the 2014 Protecting Access to Medicare Act (PAMA) and the recent 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which replaced the sustainable growth rate (SGR) formula.

We’ve analyzed the rule and identified the most important insights for CV leaders.

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How can CV specialists best partner with hospitals and primary care?

by Marissa Schwartz August 24, 2015

As explained in our recent study, CV Specialist Partnerships, CV specialists face strategic, operational, and financial imperatives to collaborate with both hospitals and PCPs. But important as they are, such collaborations are not always easy to maneuver. 

That's where our Toolkit for CV Specialist Partnerships comes in.

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New federal law requires patient disclosure of observation status

by Julie Bass August 19, 2015

Last week, President Obama signed the "Notice of Observation Treatment and Implication for Care Eligibility Act," or the NOTICE Act, into law. This law alters both the manner and timeframe in which hospitals must notify patients of their observation status.

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Bundled payments: Not just a cost-reduction strategy

by Kristen Barlow August 17, 2015

Over the past few months, bundled payments have seemingly become the reimbursement reform of choice, with the Bundled Payments for Care Improvement (BPCI) Initiative in full swing and the announcement of a proposed mandatory bundled payment program for orthopedic procedures in 75 metropolitan areas.

The cost-cutting benefits of bundled payments to payers are self-evident. Under BPCI, Medicare receives a 2-3% discount on typical fee-for-service payments. However, the enthusiasm (and controversy) over bundled payments are not fueled by cost savings alone.

The promise of bundled payments is that by better aligning provider incentives, gaps in the care continuum will be filled, providers will work together to improve care while lowering costs, and patients will receive a higher quality of overall care. In our research this year, we’ve found that at least in some cases, the promise has become reality: bundled payments are encouraging providers, and payers, to find the improvement opportunities that lie at intersections of cost reduction and quality improvement.

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How Lancaster General streamlines specialist consults for PCPs

by Kristen Barlow August 12, 2015

Despite opening the lines of communication, physicians often need more direct support to determine if a referral is appropriate. While developing their own patient-centered medical neighborhood, leaders at Lancaster General Health in Lancaster, Pa., saw an opportunity to ensure more appropriate and timely PCP referrals.

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Inside a CMS-approved pilot CV program

by Marissa Schwartz August 10, 2015

In 2011, JAMA published a study detailing that just 50% of stent procedures logged in the National Cardiovascular Data Registry were categorized as appropriate. Since then, the focus on appropriate use for CV services has only grown, given CMS’s efforts to transition to value-based care models.

One new program, the SMARTCare pilot, was awarded a $15.8 million CMS Innovation Center grant and launched at 10 sites across Wisconsin and Florida in late May 2015.

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Think readmission reduction is hard? It's about to get harder.

Megan Tooley August 5, 2015

Readmissions have been a key concern for hospital executives ever since the Hospital Readmissions Reduction Program was created by the Affordable Care Act in 2010. And it’s no surprise why. Starting in FY 2015, up to 3% of total Medicare inpatient payments were at-risk for hospitals with excessive readmissions for 5 conditions: heart failure, acute myocardial infarction (AMI), pneumonia, chronic obstructive pulmonary disease (COPD), and knee and hip arthroplasty.

But while readmission reduction isn’t a new priority, it still remains a challenge for most programs. In the third year of penalties, 75% of eligible hospitals faced fines for excess readmissions.

And it’s about to get harder. While programs are still trying to get their footing with managing readmissions for the existing conditions, CMS is adding open heart surgery—coronary artery bypass grafting (CABG)—with the payment penalty taking effect October 2016 (FY 2017 for CMS). That means hospitals are already under the microscope: based on previous years, CMS will likely base the first round of penalties on performance from July 2012 to June 2015.

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