CMS finalized its proposal to implement three distinct Episode Payment Models (EPM) focused on episodes of care for AMI (Acute Myocardial Infarction), CABG (Coronary Artery Bypass Graft), and Surgical hip/femur fracture treatment (SHFFT) excluding lower extremity joint replacement. We have made available a two new reports for Hospitals in applicable metropolitan statistical areas (MSAs) affected by this EPM. You can view your hospital’s reports in addition to detailed descriptions on the apprise portal.

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Medicare Advancing Care Coordination through Episode Payment Models
~ final rule ~

The Medicare Advancing Care Coordination through Episode Payment Models (EPM) Analysis compares a hospital’s 2015 average Medicare spending for AMI (Acute Myocardial Infarction), CABG (Coronary Artery Bypass Graft), and Surgical hip/femur fracture treatment (SHFFT) excluding lower extremity joint replacement to an estimated target and the 2015 regional average.  This analysis generally adheres to the methodology described in the Centers for Medicare and Medicaid (CMS) final rule, published in the Federal Register.  Any differences from the CMS methodology are noted in the Data Sources and Methods section below. The model program will be effective for discharges on or after October 1, 2017.

This report provides a hospital-specific analysis of episode payments for:

  • AMI model: AMI MS-DRGs 280-282 and those Percutaneous Coronary Intervention (PCI) MS-DRGs 246-251 also containing AMI diagnosis codes;
  • For CABG model: CABG MS-DRGs 231-236; and
  • For SHFFT model: SHFFT MS-DRGs 480-482.

Detailed descriptions of the analysis can be found in the report description on the Apprise portal.

EPM Estimated Quality Metrics Analysis Description

This Hospital Report providse estimates of a hospital’s EPM composite quality score, EPM quality category, the effective discount percentage, and an estimate of whether the hospital would be eligible for reconciliation payments. For each measure on the Hospital Reports, there is a graph representing the hospital’s performance in that measure compared to the nation.