Hospitals with higher than average spending in cardiology services could face penalties as a result of the CMS' proposed bundled-payment program for bypass surgery and heart attacks, according to a new analysis.
The report, conducted by healthcare consulting firm Avalere Health, examined 2013-14 data from the CMS that showed average 90-day cost for an episode of care in regions that may be mandated to implement the program.
The CMS will randomly select 98 metropolitan regions with hospitals that treat three types of cardiac care: coronary bypass surgery; heart attack patients managed with drugs and other treatments; and patients who receive percutaneous coronary intervention. The program will begin rolling out July 1, 2017.
Similar to the joint-replacement bundles, the CMS will target prices each year based on historical regional data and hospital-specific data related to the hospitalization and related care for 90 days after the patient is discharged. Hospitals that meet the targets and quality benchmarks will get to keep the savings. Those that exceed the targets will have to pay Medicare back at year-end.
Avalere found that 85% of hospitals that may be required to participate in the program would not have gains or losses exceeding $500,000 per year.
But the other 15% of hospitals could experience “significant” penalties.
Hospitals with higher cardiac-care spending are more likely to struggle to meet CMS targets. These hospitals probably treat sicker patients who lack continuum of care services that prevent costly readmissions, according to the report.
The report also broke down how spending is distributed for each cardiac-care service. Avalere found that 60% to 70% of costs for patients who undergo coronary bypass surgery or percutaneous coronary intervention are accumulated during their inpatient stay. This is in contrast to medically managed heart attack patients, where 35% of costs are related to the inpatient stay.
Caroline Pearson, lead author of the report and senior vice president of policy and strategy at Avalere, said depending on the patient, hospitals may need to look to different areas to reduce spending.
A strategy to reduce inpatient costs for hospitals that treat patients who undergo coronary bypass surgery and percutaneous coronary intervention is to change how medical devices are used, Pearson said. For most hospitals, physician preference drives medical device utilization. Hospitals and systems should consider using cost and quality to determine which devices to purchase. That would drive down spending, she said.
On average, 22% of medically managed heart attack patients are readmitted to the hospital, compared with 6% of coronary bypass surgery patients, the analysis found. For heart attack patients, Pearson said systems may need to focus on establishing continuum of care services to prevent readmissions like providing home care services and a managed-care plan.
