Tulsa hospitals included in Medicare episode payment model

Posted on: 12/21/16

The Centers for Medicare & Medicaid Services (CMS) has included Tulsa in their finalized proposal to reward or penalize hospitals for the total cost of episodes related to acute myocardial infarction (heart attack) and coronary artery bypass graft hospitalizations.

Under the episode payment model, Medicare pays hospitals a retrospective amount that rewards reductions in the total cost of services related to the heart attack or bypass surgery. The episode of care begins with the hospitalization and extends for 90 days following discharge.

CMS also expanded its mandatory episode payment model for total hip and knee replacements to include surgical treatment of hip and femur fractures. The Comprehensive Care for Joint Replacement (CJR) program, which began in January 2016, includes Oklahoma City area hospitals but no other hospitals in the state. The new Medicare heart attack and bypass episode payments will affect Oklahoma City hospitals as well as Tulsa.

The new payments are scheduled to take effect July 1, 2017. The president-elect’s choice for HHS Secretary, Rep. Tom Price, has criticized CMS for making its CJR program mandatory, and the new administration may reverse this entire program.

OHA will provide affected hospitals with financial projections of the impact of the new episode payment rules after the first of the year. For additional information, click here.  (Rick Snyder)