Learning Solutions

CMS Episode Payment Model and Cardiac Rehabilitation Payment Contractor

Econometrica is partnering with Acumen, LLC, as a subcontractor on the RMADA Episode Payment Model (EPM) and Cardiac Rehabilitation (CR) Payment Contractor Task Order for CMS. CMS is implementing two new EPMs to test the use of episode-based payment for an episode of care during and after a hospital stay related to cardiac disease. The models will provide retrospective, bundled payments to hospitals for episodes of care consisting of inpatient hospital stays followed by post-acute care. Specifically, these new models will apply to acute myocardial infarction treated either medically or with revascularization and a coronary artery bypass graft. A third model that falls under this project will test the effectiveness of incentive payments in increasing the use of CR and intensive cardiac rehabilitation (ICR) services.

The team’s work on this contract will involve developing the payment calculation methodologies, calculating payment amounts for both EPMs, and calculating incentive amounts for the CR and ICR service provision. Econometrica will provide technical assistance and support to model participants and ensure that the participating hospitals are confident in the calculation methods used for the episode-based payments and understand the processes in place for payment reconciliation under the models. Econometrica will provide a variety of services to achieve this goal, including developing clear and concise resources (e.g., factsheets, FAQ documents, and scenario sheets) and distributing them to model participants. Further, we will offer on-demand support by responding to inquiries from hospitals on a flow basis and produce monthly webinars to disseminate the information hospitals need for the model to be successful.