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Covered care includes both rehabilitative and physical therapy services provided in hospital, nursing facility, and home health settings.Target prices are initially based on a hospital’s historical costs but transition to a regional average over several years.More than 800 hospitals are participating in the model, which began its first performance year in April 2016.Shortly after finalizing the CJR project in 2016, CMS proposed and finalized new mandatory bundled payments for bypass surgery and acute myocardial infarction in 98 randomly selected market areas across the country.Under a recent interim final rule HHS delayed the beginning of the first performance period from July 1, 2017 to October 1, 2017, and solicited comment on whether the delay should extend to January 1, 2018.More than 1000 hospitals are participating in this model.
Practices provide an enhanced level of service with this fee and adhere to evidence-based treatment guidelines.
Currently, 190 practices accounting for approximately 150,000 Medicare patients are participating nationwide.
For reasons discussed in detail below, CMS also deployed two “mandatory” models that encompass all hospitals in specified geographic areas: In 2015, CMS announced this model, which requires participation from hospitals in 67 randomly selected markets for hip and knee replacements and nearly all associated care for 90 days following discharge.
Practices that meet quality objectives and achieve savings, including for drug expenditures, for a given year receive a performance-based payment in addition to the enhanced services fee.
The program began in July of 2016 and will end in 2021.