2018 cardiovascular state of the union - advisory · 2) episode payment models. 3) department of...

2018 Cardiovascular

State of the UnionFebruary 14 2018

Cardiovascular Roundtable

Megan Tooley

Practice Manager

tooleymadvisorycom

copy2018 Advisory Board bull All Rights Reserved bull advisorycom bull 35425A

5


How We Help Our Partner CV Programs

The Cardiovascular Roundtable provides CV leaders with unlimited

access to a deep repository of market data benchmarks case studies

best practices and industry knowledge

Develop Market-Leading

Strategy

Accelerate Performance

Improvement

Enhance Team Capacity

and Effectiveness

bull National meetings

webconferences

bull Facilitated professional

networking

bull Educational intensives and

tutorials

bull On-demand expert consultation

bull Financial operational

analytical tools

bull Survey-based benchmarking

reports

bull Best practice publications

implementation toolkits

bull Customized expert guidance

bull Market reports

bull Strategic planning toolkits

bull Volume estimators

forecasters

bull Real-time news and analysis

Source Cardiovascular Roundtable research and analysis

Institutions with Cardiovascular

Roundtable membershipTo learn more email us at

cardiovascularadvisorycom1300+


ROAD MAP6

The Next Wave of Health Care Reform 1

2 5 Market Realities Impacting CV Programs

3 QampA and Next Steps


7

What a Year Itrsquos Been

2017 a Roller Coaster Year in Health Care Policy


1) American Health Care Act of 2017 Better Care Reconciliation Act Obamacare Repeal and Reconciliation Act

2) Episode Payment Models

3) Department of Health and Human Services

January 20

President Trump sworn in makes

health care top priority on Day 1

bull July 25-28 Senate votes down

AHCA BCRA ORRA1

bull September 26 Senate cancels

vote on Cassidy-Graham

Key Milestones in 2017 Health Care Agenda

New President of

the United States

Attempts to Repeal

Replace the ACA Begin

Mandatory Cardiac

Bundles Cancelled

November 30

CMS cancels mandatory

CABG AMI EPMs2

New HHS3

Secretary

November 13

Alex Azar nominated for HHS

Secretary following resignation

of Tom Price


8

Raising Questions About the Future of Risk

Despite Uncertainty Payment Reform Likely to Remain in Some Form

Source Verma S ldquoMedicare and Medicaid Need Innovationrdquo The Wall Street Journal

September 19 2017 wwwwsjcom Cardiovascular Roundtable interviews and analysis

1) Centers for Medicare and Medicaid Innovation

2) Medicare Access and CHIP Re-Authorization Act

Key Questions from CV Leaders

How will the new administration

impact MACRA2 implementation

Will the new administration migrate

away from payment transformation

How will CMS prioritize value-based

initiatives moving forward

What is the future of CMMI1 and care

transformation programs (eg ACOs)

Many Reasons to Bet on the Future of

Payment and Care Delivery Reform

Strong bipartisan support for the

concept of payment reform

Near-unanimous bipartisan

support for MACRA legislation

CMS Administrator Seema Verma

has confirmed continued support

for value-based care

Current administration committed

to testing new models to deliver and

pay for health care through CMMI


9

5 Market Realities Impacting CV Programs


1

2

3

4

5

Margin pressure will only intensify for CV

CV is not just increasingly an outpatient business

but an ambulatory business

MACRA is changing physician payment as well as

how hospitals should align with physicians

As referring providers become more accountable for

population health CV will be expected to play a bigger role

The shift to risk is not abatingmdashmore CV payment will be

tied to cross-continuum cost and quality in the future


ROAD MAP10





11

Guess Whatrsquos Not Getting Repealed

Even If ACA Repealed Majority of Obama-Era Cuts Would Have Remained

1 Margin pressure will only intensify for CV

Source CBO ldquoBudgetary and Economic Effects of Repealing the Affordable Care Actrdquo June 2015 CBO ldquoLetter to the

Honorable John Boehner Providing an Estimate for HR 6079 The Repeal of Obamacare Actrdquo July 24 2012 CBO

ldquoCost Estimate and Supplemental Analyses for HR 2 the Medicare Access and CHIP Reauthorization Act of 2015

Budget of the United States Government (Proposed) FY 2016 Cardiovascular Roundtable research and analysis

1) Calculation includes ACA Inpatient Prospective Payment System Update

Adjustments ACA Disproportionate Share Hospital payment cuts MACRA

Inpatient Prospective Payment System update adjustments

ldquoProductivityrdquo Adjustments and Other Cuts to Reimbursement1

2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60

Significantly Impacting Margins

Percent of hospitals projected to

have negative margins by 2025


12

C-Suite Feeling the Cost Burden

Beginning to Trickle Down to CV Leaders

Source Boston Globe ldquoPartners Health Care cutting $600 million in costsrdquo May 12 2017 Modern Healthcare

ldquoAdvocate Health Care plans $200 million in cutsrdquo May 4 2017 Chicago Tribune ldquoEdward-Elmhurst Health

cutting $50 millionrdquo October 5 2017 Modern Healthcare ldquoDetroit Medical Center to reduce workforce to cut

$17 million in expensesrdquo November 30 2016 Cardiovascular Roundtable research and analysis

Partners HealthCare cutting $600M in costs

May 12 2017

Jim Skogsbergh CEO

ADVOCATE HEALTH CARE

Our existing cost structure is not

sustainablehellipWe believe the

transformation required to solve this

problem will take months if not years

Failing to take steps now will turn a

financial challenge into a financial

crisismdashsomething none of us wants

Detroit Medical Center to reduce

workforce to cut $17 million in expenses

November 30 2016

Edward-Elmhurst Health cutting $50 million

10052017

Advocate Health Care plans

$200 million in cuts

May 4 2017


13

CV Reimbursement Not What It Used to Be

Payment Updates Requiring Greater Efficiency

Source CMS Cardiovascular Roundtable research and analysis

1) Inpatient payments are final FY 2018 rates outpatient and physician fee schedule are proposed CY 2018

2) Unadjusted national average change values are provided for comparison purposes but direct comparisons

are difficult due to consolidation and restructuring of APCs

0516

CardiacServices

VascularServices

CV Medicare Payment Changes

2018 Versus 20171

INPATIENT OUTPATIENTPHYSICIAN FEE

SCHEDULE

Access a complete list of 2018 payment

updates on the online resource page

Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services

APC DescriptionPercent

Change2

5524 Level 4 Imaging

without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14

CV Costs Increasingly Under the Microscope

Key Market Trends Shaping the Economics of CV Care


1) Bundled Payments for Care Improvement Initiative

2) Hospital Value-Based Purchasing Hospital Inpatient Quality Reporting Merit-Based Incentive Payment System

Reimbursement Pressures

bull Payment updates not keeping

pace with increasing costs

bull MACRA holding physician

payments steady

bull Readmission reduction program

bull BPCI1 voluntary risk-based

payment models

bull New VBP IQR MIPS2 episodic

cost measures

Pay-for-Performance Programs

Scrutinizing Episodic Cost

Shifting Demand to Less

Profitable Services

bull Softening acute procedural

volumes (eg CABG PCI)

bull Shift to outpatient medical care

with lower margins

Cost-Sensitive Patients

and Referring Providers

bull Patients facing greater

out-of-pocket costs

bull Increasing price transparency

bull Referring providers

increasingly accountable for

costs under MACRA ACOs


15

No Relief in Sight

CV Demographics Increasing Cost of Care Moving Forward

Source American Heart Association ldquoCardiovascular Disease A Costly Burden for Americamdash

Projections Through 2035rdquo (2017) Cardiovascular Roundtable research and analysis

Cost of CV Disease in United States

Drivers Impacting the Rising Cost of CV Care Delivery

Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16

Carving Out a Role in Institution Efforts

Clear Opportunity for CV to Support Targeted Cost Reduction Initiatives


Savings

Potential

Difficulty

HighLow

Low

High

bull Reallocate acute care services

across system

bull Rightsize excess inpatient capacity

Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards

bull Eliminate quality

shortfalls that

increase cost

per case

bull Update labor staffing models

bull Ensure value of supply

contracting arrangements

Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17

ROUNDTABLE RESOURCESStrategies for Success

CV Guideline

Compendium

Building the High-Value

CV Care Team

Playbook for Reducing

CV Care Variation

Practicing Top-of-

License CV Care

Build long-term strategies to reduce

programs costs not just focusing on

quick wins

Build a lean provider team across settings

and services that engages each team

member in high-value care tasks

Develop care standards for areas where

care variation is contributing to high clinical

and operational costs and poor outcomes

Prioritize CV Cost

Reduction 1

Ensure Top-of-License

Care Delivery2

Reduce Variation

in Care Delivery3

Source Cardiovascular Roundtable interviews and analysis

Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18

Outmigration of CV Services Marches On

Inpatient Volumes Declining as Outpatient Takes a Greater Share

2 CV is not just increasingly an outpatient business but an ambulatory business


CV Five-Year Growth Projections by Sub-Service Line

National All-Payer 2016-2021

20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)

OutpatientMedicalVascular

OutpatientCardiac EP

OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP

Get Custom Forecasts for Your Market

Access the CV Market Estimator for five

year forecasts for CV services in your market


19

Many Factors Driving CV ldquoOutrdquo

Outpatient Shift Unlikely to Abate Given Changing Dynamics


1) Recovery audit contractor

Greater Risk for

Total Cost

Shifting services contributes to

lower total cost helps reduce

readmissions by enhancing

cross-continuum care

Market Forces Favoring Outpatient Shift of CV Services

Regulatory

Scrutiny

RAC1 audits Two-Midnight

Rule penalize for unnecessary

inpatient admissions

Need for Hospital

Efficiency

Triaging low-risk patients

to lower acuity settings

alleviates capacity constraints

Payer

Steerage

Lower-cost settings help retain

patients steered by insurers to

alternate providers

Consumer

Demands

Offering accessible care settings

shorter wait times attracts patient

and physician consumers


20

Site-Neutral Payments Shaking Up Outpatient Strategy

Already Seeing Significant Cuts to Payment Rate for Off-Campus Sites

Source Centers for Medicare and Medicaid Services

CMSgov Cardiovascular Roundtable interviews and analysis

1) Medicare Physician Fee Schedule

2) Hospital Outpatient Prospective Payment System

Access our cheat sheet on site neutral

payments on the online resource page

Hospital Sites Meeting

Three Criteriahellip

hellipReceive Less than Half of

Previous Payment in 2018

Reimbursed for all services on

site-specific MPFS1 rate set at

40 of HOPPS2 payment down

from 50 in 2017

Hospital-owned designated as

ldquooff-campus provider-based sitesrdquo

Located more than 250 yards

from hospitalrsquos campus

Acquired opened or built

after November 1 2015


21

Not the Last Wersquoll See of Payment Levelling

Keeping Services in HOPD1 Acquiring Practices No Longer a Sure Bet


1) Hospital outpatient department

2) Facilities relocated for extraordinary events eg natural disasters public safety events etc may continue billing on HOPPS

1

Site acquisition

Facility relocation2

Office expansion

Practice acquisition no longer

guarantees higher reimbursement

Future Implication

Sites Can Lose Ability to

Bill on HOPPS in Three Ways

2

CMS exploring a full

transition of impacted

sites to MPFS claims

In 2019 claims data from

impacted sites will be used

to help determine new rates

CMS may expand payment

levelling to additional sites

including those grandfathered in

Future Implication

Further Payment Reductions

Are on the Horizon


22

Tomorrowrsquos Ambulatory Strategy Looks Beyond HOPD

Long-Term Priorities Require Service Placement Outside of Hospital

Source ldquoImaging Program Expands to Include Level of Care Reviews FAQrdquo Anthem

Blue Cross Blue Shield May 2017 Cardiovascular Roundtable research and analysis

Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are

steering patients to

lower-cost providers

Benefits of Shifting Select Services

to Physician Practice Setting Case in Point

Anthem to Deny Some

On-Campus Imaging Services

bull Select Anthem insurance plans

conducting level-of-care reviews

for imaging exams

bull Will deny authorizations for

HOPD CT MRI exams not

requiring in-hospital testing

bull Ordering provider will be

given list of alternative

freestanding imaging facilities

Is Echo Next

For more information on Anthemrsquos

payment denials read our blog


23

CV Ambulatory StrategymdashNot in Name Only

CV Leaders Must Expand Focus Beyond Their Four Walls

Source 2014 Cardiovascular Roundtable CV Organizational and Leadership

Structure Survey Cardiovascular Roundtable research and analysis

1) Of respondents to 2014 Cardiovascular Roundtable member benchmarking survey

CV Involvement in Ambulatory Care

Creates Efficiencies for Program System

Principled resource

service allocation

Streamlined business

leadership functions

Unified cross-continuum

clinical strategy greater

coordination

Mutual accountability to

shared goals between

CV program and system

Yet CV Leaders Often Without

Ambulatory Oversight1

39 CV programs with direct

purview over CV

physician offices


purview over outpatient

CV clinics


24


Evaluate the financial implications of

site-neutral payments and adjust future

service placement strategy

Increase oversight of outpatient care sites

and align goals to improve coordination

across the continuum of CV care

Improve patient access to cost-effective

CV care in the community and connect

them to the hospital for necessary services

Understand the Impact

of Site-Neutral Payments1

Align CV Inpatient and

Ambulatory Strategy2

Enhance Outpatient

Presence3


Site-Neutral Payments

Cheat Sheet

Develop an Effective

Reporting Structure

Support Operational

Integration Across

CV Practices

Guide for Assembling

the Accessible CV

Network

Blueprint for CV

Growth in a

Transitioning Market


25

Payment Reform Accelerates with MACRA

With MACRA1 Underway 2017 a Pivotal Year for Value-Based Care

3 MACRA is changing physician payment as well as how hospitals should align with physicians


1) Medicare Access and CHIP Reauthorization Act of 2015

2) Medicare Incentive Payment System

3) Advanced Alternative Payment Model

4) Episode payment models

A Brief History of MACRA

92ndash8 2015 Senate vote

in favor of MACRA

2015Congress passes MACRA1

to overhaul flawed sustainable

growth rate (SGR)

2017First performance year tying

physician payment to risk

will impact 2019 payment

Access our cheat sheet on MACRA

on the online resource page

What CV Leaders Need to Know

Key strategies to maximize

performance under MIPS

Implications of each physician

payment trackmdashMIPS2 versus APM3

The future of APMs for CV following

cancellation of cardiac EPMs4

How MACRA will impact

physician hospital alignment


26

Payment Reform Accelerates with MACRA (Cont)

Source CMS Merit-Based Incentive Payment System (MIPS) and Alternative Payment

Model (APM) Incentive under the Physician Fee Schedule and Criteria for Physician-Focused

Payment Models October 14 2016 Cardiovascular Roundtable research and analysis

MACRA in Brief

bull Legislation passed in April 2015 ending the Sustainable Growth Rate (SGR) formula which

threatened significant physician payment cuts for 13 years

bull Final rule released in October 2016 with program starting January 1 2017

bull Implements the Quality Payment Program (QPP) consisting of two new Medicare payment

tracks that eligible clinicians will fall into Merit-Based Incentive Payment System (MIPS) and

Advanced Alternative Payment Models (APMs)

bull Holds physician payment updates relatively flat for 2016 onward with payment

bonusespenalties applied based on track and performance

bull Providers are required to participate in MACRA if they

ndash Bill Medicare more than $90000 per year or provide care for more than 200 Medicare patients

a year AND

ndash Are a physician PA NP clinical nurse specialist or certified RN anesthetist

bull Represents a significant move to increase pay-for-performance and risk models for physicians


27

Breaking Down the Two Tracks

Both Tracks Putting Payment at Risk

Source CMS ldquoMedicare Program CY 2018 Updates to the Quality Payment

Programrdquo June 20 2017 Cardiovascular Roundtable research and analysis

1) Providers can only earn as much in bonuses as the MIPS track collects in penalties

2) In addition to any bonuses or penalties from the payment models themselves

Merit-Based Incentive Payment

System (MIPS)

Advanced Alternative Payment

Models (APMs)

The majority of providers will fall into

this track

83-90

10-17

Of clinicians are expected

to qualify for MIPS track


to qualify for APM track

There will be winners and losers

As MIPS is a revenue-neutral program

some providers will receive a bonus and

some will pay a penalty

2020 5 2021 7 2022 9

Providers can make or lose up to1

2019 4

It is difficult to qualifymdashespecially for

CV after cardiac EPM cancellation

There is big appeal to participate

Providers in this track will receive a 5

annual lump-sum bonus2 in 2019-2024 and

a higher annual payment update in 2026+

Deciding to participate is frequently

out of CVrsquos control

With no CV-specific APMs remaining

providers must participate in another eligible

payment model (eg downside ACO)


28

Work Smarter Not Just Harder on Quality

Strategies to Maximize Performance in the Quality Category Under MIPS

Source CMS ldquoMedicare Program Merit-Based Incentive Payment System (MIPS) and Alternative

Payment Model (APM) Incentive Under the Physician Fee Schedule and Criteria for Physician-

Focused Payment Modelsrdquo Oct 14 2016 qppcmsgov Advisory Board interviews and analysis

1) Physician Quality Reporting System

bull Track list of metrics

over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics

bull Identify eligible

measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report

bull Evaluate results to

determine highest

performing measures

bull Compare performance

to publically available

benchmarks on select

quality metrics

(eg registries

Hospital Compare)

Starting

2018Full-year reporting required

for all submission methods

Tips for Success


29

Doubling Down on Cost

Tying Physician Payment to Episodic Cost Metrics

1) 2018 MACRA QPP Final Rule

Category Weighting Under MIPS

60 5030

2525

25

1515

15

1030

2017 2018 2019+


Programrdquo November 2 2017 Cardiovascular Roundtable research and analysis

Quality Advancing Care Information

Improvement Activities Cost

By Performance Measurement Year1 Cost Metrics

1

2

3

Total per capita cost

Medicare spend

per beneficiary

May include condition-specific

episode-based measures as

early as performance year 2019

CMS has been evaluating

bull Acute inpatient conditions

(eg AMI chest pain)

bull Chronic conditions

(eg AF HF)

bull Procedural episode groups

(eg CABG ICD implant)

Ensure Patients are Attributed to a PCP

bull Attribution for total per capita cost is based on

patientrsquos utilization of primary care

bull Specialists can reduce the likelihood of attribution

by encouraging patients to visit their PCP


30

APMs Not Primed for CV

Majority of Existing Qualifying Models Out of CV Leadersrsquo Control

Source CMS ldquo2018 Updates to the Quality Payment Programrdquo (2017) HHS

ldquoSecretaryrsquos Response to the ACS-Brandeis Advanced APMrdquo September 7 2017

available at wwwinnovationgov Cardiovascular Roundtable research and analysis

But New APMs on the Horizon

May Be Positive Signs for CV

BPCI Advanced

Voluntary risk-based

payment models for select

CV conditions services

beginning October 1 2018

Medicare Advantage

Becomes eligible for APM track

starting in 2019 performance year

Private Payer Models

Example ACS-Brandeis APM

Includes CABG valve surgery

and HF recently approved for

limited testing

Responsible entity can be a group

of physicians rather than a hospital

Even providers selected for cardiac

EPMs may have had difficulty meeting

the thresholds to qualify for APM track

bull Receive 25 of Medicare

payments through APM (50 for

2019 performance year) or

bull See 20 of Medicare

patients through APM (35 for

2019 performance year)

Majority of APMs centered around

primary care (eg ACOs)

Even if participating in an APM

programs still have to meet high

payment volume thresholds

Limitations of APM Models for CV


31

An Environment Ripe for Partnership

MACRA Will Drivemdashand RequiremdashHospital-Physician Alignment

Source Medical Group Management Association 2017 Cost and

Revenue Survey Cardiovascular Roundtable research and analysis

$15128IT operating expenses

per FTE physician at a

physician-owned CV practice

Improve performance under MIPS

Offload reporting burden

Stabilize practice economics

Case in Point IT Expense

Think Strategically About Alignment

Hospitals employing physicians

will be accountable for physician


Programs may restructure physician

incentive models to incorporate metrics

impacting performance under MACRA

Physicians Will Increasingly Look to

Employment TohellipHealth Systems Shouldhellip

Consider opportunities to scale

physician network to support new

or existing risk contracts


32


Design Effective

CV Physician

Compensation Models

Educate physicians and CV leaders on

the implications of MACRA and how to

be successful

Be selective in employing physicians as

hospitals will be financially accountable

for employed physician performance

under MIPS

Structure physician compensation

models to include metrics that align with

those you are at-risk for under MACRA

Learn More

About MACRA1

Carefully Evaluate Your

Physician Alignment Strategy 2

Redesign Incentives to Align

with New Metrics of Success3


MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov

Advancing CV Hospital-

Specialist Alignment


33

Primary Care at Center of Population Health Efforts

Seeing Continued Interest in ACOs but CV Often Left On the Sidelines

4 As referring providers become more accountable for population health CV will be expected to play a bigger role

Source CMS available at datacmsgov Advisory Board ldquoWhere the ACOs arerdquo

available at advisorycom Cardiovascular Roundtable interviews and analysis

220

353 404

474 525

2013 2014 2015 2016 2017

Yet CV Leaders Rarely

Involved in ACO Decisions

ACO Participation Continues to Grow

Total ACO Participants by Performance Year

VP Heart amp Vascular Services

Large Hospital in the Midwest

Our physicians are assigned to

an ACO on the contract but

as far as our involvement

Irsquod say minimal at bestrdquo

Director of CV Services

AMC in the Northeast

Wersquove received a global view

and know the goals of the

ACO but we havenrsquot quite

formulated our strategies to

function as one in CVrdquo


34

Risks of Non-Action Too Great to Ignore

Accountable PCPs1 Changing Referral Patterns to CV Specialists


1) Primary care providers

2) Pseudonym

3) Aortic stenosis

Potential Consequences for CV

Due to Care Redesign Initiatives

ACO PCPs hesitant to

refer patients for high-

cost specialty services

Patients referred later in

disease progression with

more acute needs

CV program locked out of

referral network if not

demonstrating high-value care

An Extreme Example Curie Hospital2

bull Large CV program with robust

structural heart program

bull Hospital-employed PCPs joined ACO

started referring fewer valve patients

due to fear patients would receive

expensive treatments (eg TAVR)

bull Structural heart program sees volume

decline threatens stability

bull Patients with AS3 referred too late in

disease progression

PCPs Acting as Gatekeeper for

High-End CV Care


35

Positioning CV to Succeed Under Care Redesign

Programs Must Demonstrate Value to Secure Continued Referrals


Secure Referrer

Trust

Strengthen referring

physician alignment

by demonstrating

positive outcomes and

appropriate utilization

Improve Patient

Access

Ensure timely

convenient referrals

and appointments in

accessible care

settings

Provide Quality

Care at Low Cost

Deliver high-quality

low-cost care to

demonstrate high-

value CV care delivery

Imperatives for Success Under Care Redesign Initiatives

Market to Providers

Based on Value

Emphasize quality of

care appropriate

utilization and cost

reduction efforts to

attract referring PCPs


36

A New Role for CV in Population Health

Million Hearts Initiative Puts Primary Prevention in the Spotlight

Source CMS ldquoMillion Heartsrdquo httpsinnovationcmsgov ldquoMillion Hearts Meaningful Progress

2012-2016rdquo Ritchey M et al ldquoMillion Hearts Description of the National Surveillance and Modeling

Methodology Used to Monitor the Number of CV Events Prevented During 2012-2016rdquo J Am Heart

Assoc 6 no 5 (2017) e006021 Cardiovascular Roundtable research and analysis

1) Defined as heart attacks strokes and other CVD-related ED encounter or

hospitalization with a primary ICD9 or death code Million Hearts estimation

2) Cardiovascular disease

3) Transient ischemic attack

500KCV events1 prevented

between 2012 and 2016

bull CMS initiative launched in 2011

bull Goal to prevent one million

heart attacks and strokes

bull Provides guidance on CV

primary prevention efforts

Million Hearts Initiative

33MMedicare fee-for-service

beneficiaries

20KHealth care

practitioners

Expected Program Reach by 2021

bull Million Hearts CVD2 Risk Reduction Model

launched in 2016

bull 516 organizations selected to participate

bull Participants receive a stipend for managing

patients at high-risk of CVD who have not

yet had a heart attack stroke or TIA3

New Model Tying Payment to Prevention

Successfully Preventing

CV Events


37

A New Role for CV in Population Health (Cont)

Source ldquoMillion Heartsrdquo CMS httpsinnovationcmsgovl ldquoMillion Heartsrdquo HHS httpsmillionheartshhsgov

ldquoMillion Hearts Meaningful Progress 2012-2016rdquo HHS Cardiovascular Roundtable research and analysis

1) Centers for Disease Control and Prevention

Million Heartsreg

bull CMS CDC1 initiative launched in 2011 goal to prevent 1 million heart attacks and strokes

through clinical- and community-based strategies through ABCS approach

ndash Aspirin for high-risk patients Blood pressure control Cholesterol level management

Smoking cessation

ndash Preliminary results through 2016 show risk reductions

bull Million Hearts Risk Reduction Model CMMI pilot established in 2016 including over 500

participating practices clinicians and health systems

ndash First model tying payment to CV risk reduction incentivizing primary prevention of CVD

bull Million Hearts 2022 reinforces emphasis on CV risk reduction goals through 3 aims

ndash Focus on at-risk populations

ndash Optimize care

ndash Keep people healthy

bull Million Hearts 2022 also sets goal to increase cardiac rehab participation from 20 to 70

ndash Expected effects in first year of 70 utilization 12000 lives saved 87000 hospitalizations

prevented


38

Expanding the Focus to Secondary Prevention

Cardiac Rehab Front and Center in Million Hearts 2022

Source ldquoMillion Heartsrdquo CMS httpsinnovationcmsgov ldquoMillion Heartsrdquo HHS httpsmillionheartshhsgov

ldquoMillion Hearts Meaningful Progress 2012-2016rdquo HHS ldquoMillion Hearts 2022rdquo HHS Ades PA et al ldquoIncreasing

Cardiac Rehabilitation Participation From 20 to 70 A Road Map From the Million Hearts Cardiac Rehabilitation

Collaborativerdquo Mayo Clin Proc 92 no 2 (2017) 234-242 Cardiovascular Roundtable research and analysis

Million Hearts 2022 Sets

Ambitious Cardiac Rehab Goal

20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization

Increase appropriate enrollment

Increase patient attendance

Optimize program efficiency

Strategies to Increase Cardiac

Rehab Utilization

Read more from Million Hearts to

learn targeted effective strategies to

increase cardiac rehab utilization


39

Cardiac Rehab Getting More Attention

Expansion to Secondary Prevention Not Just a Focus in Million Hearts

Source Keteyian S ldquoDoing Away with Outdated Dogma in Cardiac Rehabilitationrdquo AACVPR 2017 Workshop ldquoMedicare Program

Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models

Changes to Comprehensive Care for Joint Replacement Payment Modelrdquo CMS Cardiovascular Roundtable research and analysis

1) Heart failure with preserved ejection fraction

INCREASED SUPPORT

EXPANDED COVERAGE

Cardiac rehab covered

by CMS for expanded

conditions (eg HFrEF1)

New CMS determination covers

exercise therapy for patients

with peripheral artery disease

Some commercial payers

now reimburse

home-based rehab

Cardiac rehab and exercise

training is a Class 1A

recommendation

CMS considering new voluntary

payment model after

cancellation of Cardiac Rehab

Incentive Payment Model


40

Redefining CVrsquos ldquoBest in Classrdquo

New Comprehensive Accreditations Mandate Population Health Focus

Source ldquoFacts about Comprehensive Cardiac Center Certificationrdquo The Joint Commission available at

wwwjointcommissionorg ldquoCardiovascular Center of Excellence Program Overview and Eligibility v13rdquo

American Heart Association available at wwwheartorg Cardiovascular Roundtable intervies and analysis

Population Health a Requirement

of Both Accreditations

Use of a national registry

or data tool to monitor

data measure outcomes

CV risk factor identification

and disease prevention

Access to cardiac rehab

services secondary

prevention education

Focus on streamlined timely

patient transitions between

referrers and CV specialists

Two New Accreditations Available

for Comprehensive CV Programs

Cardiovascular Center of Excellence

Comprehensive Cardiac

Center Certification


41


Enhancing CV

Specialist Partnerships

with Primary Care

Give PCPs guidance and tools to help

them identify and refer CV patients

earlier in disease progression

Develop profitable effective cardiac

PAD and pulmonary rehab and make

sure patients are referred and attend

Tailor cross-continuum care management

services to patients based on risk

Help PCPs Identify

CV Patients1

Increase Utilization of CV

Rehab Programs2

Improve Care Management

for High-Risk Patients3


CV Referral

Guideline

Compendium

Tactics for Sustainable

Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42

The Risemdashand Fallmdashof Mandatory Cardiac Bundles

CMS Cancels Mandatory Cardiac EPMs Before They Begin

5 The shift to risk is not abatingmdashmore CV payment will be tied to cross-continuum cost and quality in the future


1) Center for Medicare and Medicaid Innovation

bull New administration opposes

mandatory payment pilots

bull CMMI cancels EPMs

bull CMS indicated plan to develop new

voluntary bundled payment model(s)

for 2018 building on BPCI

and designed to meet APM criteria

July 2016

Cardiac Episode Payment Model (EPM) Timeline

December 2016 November 2017March 2017 May 2017

bull CMMI1 announces first mandatory

cardiac episode payment models

bull Retrospective 90-day bundles

for AMI and CABG

bull Hospitals responsible party for

entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43

(Voluntary) Bundles are Back


1) Convener participant brings together multiple downstream episode initiators coordinates participation

and bears and apportions risk non-conveners only bear financial risk on their own behalf

2) Provider must have 50 of Medicare fee-for-service payments or 35 of patients through Advanced

APMs to qualify in performance year 2019

Retrospective 90-day bundles

Acute care hospitals and physician group

practices are eligible episode initiators either as

convener or non-convener participants1

Qualifies as an Advanced Alternative Payment

Model for MACRA participants may be eligible for the

APM bonus if they meet paymentpatient thresholds2

Downside risk begins day 1 unlike BPCI 10 there

will not be a phase-in period for risk

Applicants do not have to select episodes until August

2018 and can see target prices before joining

January 11 2018

Application portal opens

March 12 2018

Applications due must name

all episode initiators

May 2018

CMS provides target

prices to applicants

June 2018

CMS releases

Participation Agreements

August 2018

Participation Agreements due to

CMS must select clinical episodes

Providers Must Act Quickly

YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44

Bundles Shift Outpatient

Providers Can Select CV Outpatient Episodes in BPCI Advanced


bull Acute myocardial infarction (AMI)

bull Cardiac arrhythmia

bull Cardiac defibrillator

bull Cardiac valve

bull Congestive heart failure (CHF)

bull Coronary artery bypass graft (CABG)

bull Pacemaker

bull Percutaneous coronary

intervention (PCI)

bull Stroke

CV Clinical Episodes Included in BPCI Advanced


bull PCI

Inpatient Outpatient

This is the first time

outpatient episodes are

included in CMS bundled

payment models (eg

BPCI EPMs)

Learn More About BPCI Advanced Watch our recent on-demand

webconference on the new model

BPCI Advanced Everything You

Need to Know

Your Questions About BPCI

AdvancedmdashAnswered


45

More Risk on the Table Than Ever Before

Mandate for Managing Long-Term Costs Extends Beyond EPM Rule

Source Verma S ldquoMedicare and Medicaid Need Innovationrdquo The Wall Street Journal September 19

2017 wwwwsjcom Burwell SM ldquoProgress Towards Achieving Better Care Smarter Spending Healthier

Peoplerdquo HHS January 26 2015 wwwhhsgov Cardiovascular Roundtable research and analysis

1) Inpatient Quality Reporting

2) Value-Based Purchasing Program

Medicare Fee-for-Service Initiatives Emphasizing Value

bull Cost category 30 of

MIPS score in 2019 bull AMI HF excess days in

acute care (IQR1 2018)

bull AMI HF 30-day episodic

payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing

episodic-cost measures

Episodic value measures added

to pay-for-performance quality

reporting programs eg

New voluntary bundled

payment model ldquoBPCI

Advancedrdquo announced

for 2018

50HHS goal for percent of Medicare payment

in alternative payment models by 2018

CMS Still Pushing Toward Risk

MACRA Pay-for-Performance Bundled Payments


46

Private Sector Spurring More Innovation

Risk-Based Payment Models Not Losing Steam for Private Payers

Source Health Care Transformation Task Force ldquoHealth Care Transformation Task Force Urges

Incoming Administration and Congress to Continue Drive for Value-Based Paymentsrdquo December

6 2016 available on wwwhcttforg Cardiovascular Roundtable research and analysis

1) Smarter Management And Resource use for Todayrsquos complex cardiac Care

2) Medicaid-led multi-payer multi-part payment model

Percent of payments to

be tied to risk-based

payment models by 2020

Commitment from Health Care

Transformation Task Force

Sample Private Sector Payment Innovations Impacting CV

The SMARTCare1 program has

proposed a bundled payment

for diagnosis and treatment of

stable ischemic heart disease

Horizon Blue Cross Blue Shield

of New Jerseyrsquos Episodes of

Care program includes HF

and CABG episode payments

Arkansas Health Care

Payment Improvement

Initiative2 includes HF and

CABG episode payments

75


47

Medicare Advantage Increasing its Reach

Private Models Testing Payment Innovation in Medicare

Source CMS CBO ldquoMarch 2015 Medicare Baselinerdquo March 9 2015

available at wwwcbogov Cardiovascular Roundtable research and analysis

MA1 Continues to Grow

Enrollment in Millions Percentage

of Total Medicare Population

56M

(13)

168M

(31)

202520152005

300M

40

CMS testing Medicare Advantage

Value-Based Insurance Design (VBID)

Model for enrollees in select states with

defined chronic conditions2

Medicare Advantage will count as

a MACRA APM starting in 2019

performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality

1) Medicare Advantage

2) Including diabetes CHF past stroke hypertension COPD CAD

Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management

Identify where you have the greatest

opportunity to reduce costs across the

continuum as both public and private

payers increase scrutiny

Provide high-quality cross-continuum care

to attract patients providers and payers

and reduce unnecessary utilization

1

Improve Quality of Care

2

3



CV Care Variation

Learn More About

2018 Medicare Updates

Reduce Episodic

Care Costs

Medicare Payment

Update Final Rule for

Hospital Inpatient

Payments for FY 2018

Medicare Payment


Hospital Outpatient

Payments for CY 2018

CV Readmission

Reduction Toolkits

Understand what metrics your program

will be measured against in Medicare

pay-for-performance programs

Care Coordination

Episode Profiler


49

The Perils of Teaching to the Test

Reactive Strategies Not Pathways to Success in an Uncertain Market


2010 2016

30-day HF Readmission

Penalties Announced

Response

Mandatory cardiac bundles

cancelled

No-Regrets Priorities

Build an infrastructure to

eliminate unwarranted care

variation implement evidence-

based care standards

Partner across the continuum

to improve outcomes and costs

Prioritize investments based on

the demands of your market

Lower the cost of care delivery

with appropriate staffing

utilization

Old Response to Risk New Plan for Risk

bull Focus on HF

bull Hire HF nurse navigators

bull Focus on 30-days

post-discharge

Mandatory Cardiac

Bundles Announced

Response

bull Redesign physician

incentives to support

CABG AMI outcomes

bull Support PAC providers in

delivering high-quality

care through 90 days

First mandatory cardiac

bundles track CABG AMI

outcomes for 90-days

Planning for an

Uncertain Future

Market Shift Market Shift

2018+


50



1

2

3

4

5





how hospitalrsquos should align with physicians






ROAD MAP51





52

More from the Cardiovascular Roundtable


CV Market Update

Member Networking Session

Blueprint for CV Growth in a


Building the High-Value Care Team

Playbook for Reducing Care Variation

Remaining Sessions

bull March 5-6 | Washington DC

bull March 22-23 | Atlanta GA

bull April 9-10 | Chicago IL

Register at advisorycomcr2017meeting

Latest Research

CV Surgery Planning for

Success in a Changing Market

How to Optimize Your Cardiac

Rehab Program

Develop Your Structural Heart

Program for 2018 and Beyond

2017-18 National Meeting Series

To learn more email us at

cardiovascularadvisorycom


5


How We Help Our Partner CV Programs

The Cardiovascular Roundtable provides CV leaders with unlimited

access to a deep repository of market data benchmarks case studies

best practices and industry knowledge

Develop Market-Leading

Strategy

Accelerate Performance

Improvement

Enhance Team Capacity

and Effectiveness

bull National meetings

webconferences

bull Facilitated professional

networking

bull Educational intensives and

tutorials

bull On-demand expert consultation

bull Financial operational

analytical tools

bull Survey-based benchmarking

reports

bull Best practice publications

implementation toolkits

bull Customized expert guidance

bull Market reports

bull Strategic planning toolkits

bull Volume estimators

forecasters

bull Real-time news and analysis


Institutions with Cardiovascular

Roundtable membershipTo learn more email us at

cardiovascularadvisorycom1300+


ROAD MAP6





7







January 20




AHCA BCRA ORRA1




New President of

the United States

Attempts to Repeal


Mandatory Cardiac

Bundles Cancelled

November 30


CABG AMI EPMs2

New HHS3

Secretary

November 13



of Tom Price


8





























9



1

2

3

4

5











ROAD MAP10





11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







ROAD MAP6





7







January 20




AHCA BCRA ORRA1




New President of

the United States

Attempts to Repeal


Mandatory Cardiac

Bundles Cancelled

November 30


CABG AMI EPMs2

New HHS3

Secretary

November 13



of Tom Price


8





























9



1

2

3

4

5











ROAD MAP10





11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







7







January 20




AHCA BCRA ORRA1




New President of

the United States

Attempts to Repeal


Mandatory Cardiac

Bundles Cancelled

November 30


CABG AMI EPMs2

New HHS3

Secretary

November 13



of Tom Price


8





























9



1

2

3

4

5











ROAD MAP10





11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







8





























9



1

2

3

4

5











ROAD MAP10





11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







9



1

2

3

4

5











ROAD MAP10





11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







ROAD MAP10





11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







11












2017 2018 2019 2020 2021 2022 2023 2024 2025

($32B)

($48B)($60B)

($71B)($82B)

($94B)($103B)

($116B)

($143B)

60





12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







12








May 12 2017

Jim Skogsbergh CEO











November 30 2016


10052017



May 4 2017


13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







13







0516

CardiacServices

VascularServices


2018 Versus 20171


SCHEDULE



Cardiology

Cardiac

Surgery

Vascular

Surgery

Select CV Services


Change2


without

Contrast (eg

transthoracic

eco)

83

5212 Level 2 EP

Procedures

(eg ablation

of AV node)

62-20 -20 -20


14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







14










payments steady



payment models


cost measures




Profitable Services




with lower margins




out-of-pocket costs






15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







15

No Relief in Sight






Increase in

staffing costs

Investment in more

complex expensive

technologies

Increasingly

chronic comorbid

patient population

2016

$555 billion

2035

$11 trillion


16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







16




Savings

Potential

Difficulty

HighLow

Low

High


across system


Minimize

Unwarranted

Care Variation

Restructure Fixed

Cost amp Assets

Reduce Labor and

Supply Costs

bull Develop a

foundation for

implementing

care standards


shortfalls that

increase cost

per case




Focus of C-Suite

health system

executives

More within

CVrsquos realm

of control


17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







17


CV Guideline

Compendium


CV Care Team


CV Care Variation

Practicing Top-of-

License CV Care



quick wins







Prioritize CV Cost

Reduction 1


Care Delivery2

Reduce Variation

in Care Delivery3


Playbook for CV

Episodic Cost

Management

CV Margin

Management

Resource Center

(coming soon)


18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







18







20 20 19

10

(3) (4)(6)

(8)

(12) (13)

(19)



OutpatientVascular

Cath

OutpatientMedical

Cardiology

Inpatient

Arterial

Disease

Inpatient

Cardiac

Surgery

Inpatient

Cardiac

Cath

Outpatient

Cardiac

Cath

Inpatient

Medical

Cardiology

Inpatient

Other

Vascular

Inpatient

Cardiac EP





19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







19





Greater Risk for

Total Cost






Regulatory

Scrutiny




Need for Hospital

Efficiency




Payer

Steerage



alternate providers

Consumer

Demands





20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







20
















from 50 in 2017








21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







21






1

Site acquisition


Office expansion



Future Implication



2










Future Implication


Are on the Horizon


22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







22





Lower copays

for patients

Payment rate

differential less

significant than

in the past

Community practice

more accessible to

patients providers

More attractive to

payers who are





Anthem to Deny Some




for imaging exams







Is Echo Next




23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







23








Principled resource

service allocation





coordination







purview over CV

physician offices



CV clinics


24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







24















Enhance Outpatient

Presence3



Cheat Sheet


Reporting Structure

Support Operational

Integration Across

CV Practices


the Accessible CV

Network

Blueprint for CV

Growth in a



25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







25











in favor of MACRA



growth rate (SGR)
















26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







26





MACRA in Brief











a year AND




27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







27








System (MIPS)


Models (APMs)


this track

83-90

10-17









2020 5 2021 7 2022 9


2019 4













28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







28








over the year

bull Aim to improve

performance across

all metrics

Improve

Program

Performance

Measure

Against

Benchmarks

Identify

Highest

Performers

Create Target

List of CV

Metrics


measures previously

reported in PQRS1

bull Review list of

MIPS metrics to

identify additional

measures to report


determine highest

performing measures




quality metrics

(eg registries

Hospital Compare)

Starting



Tips for Success


29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







29





60 5030

2525

25

1515

15

1030

2017 2018 2019+






1

2

3


Medicare spend

per beneficiary






(eg AMI chest pain)


(eg AF HF)









30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







30








BPCI Advanced





Medicare Advantage







limited testing



















31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







31

























32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







32


Design Effective

CV Physician

Compensation Models



be successful




under MIPS




Learn More

About MACRA1






MACRA

Cheat Sheet

MACRA How the

2018 Quality

Payment Program

Final Rule Impacts

Providers

MIPS measures

picklist at

qppcmsgov




33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







33






220

353 404

474 525

2013 2014 2015 2016 2017



















34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







34





2) Pseudonym

3) Aortic stenosis








more acute needs














disease progression


High-End CV Care


35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







35




Secure Referrer

Trust


physician alignment

by demonstrating



Improve Patient

Access

Ensure timely


and appointments in

accessible care

settings

Provide Quality

Care at Low Cost


low-cost care to

demonstrate high-



Market to Providers

Based on Value


care appropriate





36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







36




















beneficiaries

20KHealth care

practitioners



launched in 2016







CV Events


37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







37





Million Heartsreg




Smoking cessation







ndash Optimize care




prevented


38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







38









20

70

Current cardiac

rehab utilization

Million Hearts

goal for cardiac

rehab utilization





Rehab Utilization





39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







39







INCREASED SUPPORT

EXPANDED COVERAGE


by CMS for expanded






now reimburse

home-based rehab



recommendation


payment model after




40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







40














services secondary











41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







41


Enhancing CV


with Primary Care









Help PCPs Identify

CV Patients1


Rehab Programs2




CV Referral

Guideline

Compendium


Pulmonary Rehab

Program Development

Blueprint for CV

Care Management

How to Optimize

Your Cardiac

Rehab Program


42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







42













July 2016






for AMI and CABG


entire care episode

Proposed Rule

released

Final Rule released

98 selected markets

announced

Start date delayed

from July 1 2017

to October 1 2017

Start date

further delayed to

January 1 2018

CMS finalizes

proposal to cancel

EPMs


43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







43


















January 11 2018


March 12 2018



May 2018

CMS provides target


June 2018

CMS releases


August 2018




YEAR 1 BEGINS 10118

1

2

3

4

5

Five Things to Know

About BPCI Advanced


44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







44







bull Cardiac valve



bull Pacemaker


intervention (PCI)

bull Stroke



bull PCI





payment models (eg

BPCI EPMs)




Need to Know




45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







45













payment (VBP2 2021)

Alternative

Payment

Models

MACRA emphasizing








for 2018






46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







46























Payment Improvement



75


47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







47








56M

(13)

168M

(31)

202520152005

300M

40







performance year

Implications on

CV Programs

More

capitation

Tying more payment

to cost quality



Focus on closing

care gaps


48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







48


Playbook for CV

Episodic Cost

Management








1


2

3



CV Care Variation

Learn More About


Reduce Episodic

Care Costs

Medicare Payment


Hospital Inpatient


Medicare Payment


Hospital Outpatient


CV Readmission

Reduction Toolkits




Care Coordination

Episode Profiler


49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







49




2010 2016


Penalties Announced

Response


cancelled












utilization


bull Focus on HF



post-discharge

Mandatory Cardiac

Bundles Announced

Response



CABG AMI outcomes







Planning for an

Uncertain Future


2018+


50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







50



1

2

3

4

5











ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







ROAD MAP51





52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program







52



CV Market Update






Remaining Sessions





Latest Research




Rehab Program






2018 cardiovascular state of the union - advisory · 2) episode payment models. 3) department of...

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