Posts in Category: Bundled payments


Value-based care is here to stay, will get boost from analytics, study says

Despite 2017’s cancellation of mandatory bundled payments, the value-based care movement in the United States is still healthy and will benefit in 2018 from analytics, according to a report from Washington, D.C.-based healthcare consulting firm Avalere.

In “2018 Healthcare Industry Outlook,” Avalere says new ways to collect data and advanced analytic capabilities are revitalizing efforts to turn data into insights that can inform policy and improve clinical workflows. This supports the shift to value-based care, which has continued even as the Trump administration backs away from large-scale mandatory models.

In November, the Centers for Medicare and Medicaid Services (CMS) canceled a plan for mandatory hip fracture and cardiac bundled payments that was slated to go into effect Jan. 1, sparking some concern that the action signaled a move away from value-based care. But then on Jan. 9, the CMS launched a new, voluntary bundled payment model that will be considered an alternative payment model (APM) for purposes of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reporting.

This, along with evidence from Avalere that the private sector has not reversed course, tells us that interest in strategies to move away from the traditional fee-for-service payment model has not waned.

“Despite political transitions and revisions to Medicare bundled payment programs, the U.S. healthcare system’s transition to APMs has remained steady,” the report says. In 2017, some of the largest commercial plans were running nearly 50 percent of their medical spend through APMs and aim to go higher, according to Avalere.

Because value-based care rewards healthcare providers who prioritize better outcomes for their patients, leaders are turning to technology investments that can lower costs and improve care quality. Avalere says that data reliability and accessibility, including capturing information and creating algorithms, will drive outcomes-based contracting and a transition toward APMs.

“Success in APMs will require providers to create better infrastructure for proactive care management, data analytics, and timely integration of disparate data,” the report says. “More widespread availability of real-world data will enable new entities to leverage analytics and insight to benefit patients and their providers.”

An outcomes-driven environment requires fast and easy access to clinical and financial intelligence that can shine a light on the best possible course forward. To learn how LUMEDX data analytics can help your organization in the transition to value-based care by becoming more efficient and improving patient satisfaction, get information about the Cardiovascular Performance Program or email us at

CMS Delays Cardiac Bundled-Payment Program  

The Centers for Medicare and Medicaid Services (CMS) has pushed back the implementation date for its bundled payments for cardiac care from July 1 until Oct. 1, according to Cardiovascular Business. It also suggested it could further delay the model until Jan. 1, 2018.

CMS announced the delay of the program, titled the Cardiac Rehabilitation Incentive Payment Model, this week in the Federal Register.

The bundled-payment program would allow approximately 1,120 acute care hospitals in 98 designated markets to hold on to the savings they achieve if they spend less than the target price for a 90-day episode of care for bypass and heart attack patients. However, hospitals that exceed the target price must repay Medicare -- and target prices will be determined retrospectively.

CMS previously predicted that the program - which also covers knee and hip replacement - would save the federal government as much as $159 million between now and 2021. In 2014, the CMS said, heart attack treatment for 200,000 patients cost Medicare more than $6 billion.

The new Secretary of Health & Human Services, Tom Price, has been a critic of the program, objecting to the mandatory nature of the initiative. Seema Verma, the new CMS administrator, said during her confirmation hearing in February that she preferred a gradual expansion of new payment models, Cardiovascular Business reported.

The CMS announcement said an additional three-month delay is necessary to allow time for additional review, "to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps."

CMS added that participants would have more time to prepare for these models with the delay and that it would be preferable for payment periods to align with the calendar year. As a result, the CMS said, it is seeking comment on delaying the bundles until January 2018.


From one hospital to another, the cost of treating heart attack patients varies by as much as 50 percent. Does your hospital have a plan to meet the target prices for bypass and heart attack patients? LUMEDX's Cardiovascular Performance Program can help. Click here to find out how.

Are You Ready for the New Cardiac Bundled-Payment Program? 

Heart hospital across the country are preparing for the new mandatory bundled-payment program for cardiac care. Set to begin this July, the program makes hospitals in certain markets accountable for the quality and cost of care for bypass and heart attack patients until 90 days after discharge.

CMS predicts that the program-which also covers knee and hip replacements-will save the federal government as much as $159 million between now and 2021. In 2014, the CMS said, heart attack treatment for 200,000 patients cost Medicare more than $6 billion. From one hospital to another, the cost of treating heart attack patients varies by as much as 50 percent, according to Modern Healthcare.

The bundled-payment model allows hospitals to keep the savings they achieve if they spend less than a target price for an episode of care. However, hospitals that exceed the target price must repay Medicare. Target prices will be determined retrospectively.

LUMEDX offers a path to meeting or beating those targets. Our Cardiovascular Performance Program helps facilities gather the consolidated CV data they need to see and manage quality and cost of care in real time. The program helps CV service lines analyze their data, identify higher-risk patients and act to ensure they are performing at or better than national targets so they can keep any savings they have realized-and avoid repaying Medicare. 

Inpatient costs are likely to account for most of the cost of the 90-day bundled-payment period, and LUMEDX is uniquely positioned to help providers reduce those expenses. Our Cardiovascular Performance Program can help CV service lines contain costs while improving outcomes by reducing:

  • Door-to-balloon time
  • Door-to-Troponin-testing time
  • PCI and CABG complications
  • PCI and CABG cost-per-case variation

These are just a few of the many ways LUMEDX solutions can help heart hospitals demonstrate best-quality, best-value care delivery-and uncover the solutions to radical improvement. 

How will the bundled-payment program impact your CV service line? Share your thoughts in our comment section, below. 

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