CMS finalized new cardiac and orthopedic bundled payment models on December 20, 2016, which will reward hospitals who work together with physicians and SNFs to avoid complications, prevent rehospitalizations, and speed recovery. These new payment models intend to improve cardiac and orthopedic care as well as patient outcomes.
Cardiac care payment model: Three new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery.
Orthopedic care payment model: One new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement. In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.
CMS encourages hospitals, physicians, and post-acute care providers to use these new payment models as an educational opportunity to collaborate, share best practices, and improve coordination of care from the initial hospitalization through recovery. These bundles will begin July 2017. Premier Therapy will be providing further education this spring.
The House of Representatives has announced that it has reached a deal on a permanent fix for the Sustainable Growth Rate (SGR)—the flawed Medicare payment formula. Although ASHA staff have not seen the final compromise, it appears that extenders (e.g., therapy caps) were not permanently repealed. Therefore, the therapy cap exceptions process has been given only a 2-year extension without a repeal.
Please call and write your Senators and Representative today through the Capitol Switchboard at 202-224-3121 and take action online to tell them that the Medicare therapy cap must be addressed in the permanent SGR package.
You can also directly tweet your members of Congress!
We also encourage you to call Speaker of the House, John Boehner at 202-225-0600, and Democratic Leader, Nancy Pelosi at 202-225-0100, to express your support for a repeal of the Medicare therapy cap in any SGR reform package.
Take Action Here
The Medicare cap on outpatient rehabilitation therapy services was originally instituted under the Balanced Budget Act of 1997, as a combined cap on speech-language pathology (SLP) and physical therapy (PT) services, as well as a separate cap on occupational therapy (OT) services to Medicare beneficiaries. ASHA, along with other stakeholder groups, have worked tirelessly with both the House and Senate to develop a replacement strategy, which was included in last year’s bicameral, bipartisan agreement.
For more information, please visit our Issue Brief on the Medicare Outpatient Therapy Cap .
Write your Members of Congress Here