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医疗保险计划;通过按病种付费模式(EPMs)推进护理协调;心脏康复激励支付模式;以及全关节置换综合护理模式(CJR)的变更。最终规则。

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

出版信息

Fed Regist. 2017 Jan 3;82(1):180-651.

Abstract

This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

摘要

本最终规则实施了三种新的医疗保险A部分和B部分的诊疗费用支付模式、一种心脏康复(CR)激励支付模式,并对《社会保障法》第1115A条规定的现有全关节置换综合护理模式进行了修改。某些选定地理区域的急症医院将参与针对医疗保险按服务收费受益人在急性心肌梗死、冠状动脉搭桥术和手术性髋部/股骨骨折治疗期间接受服务的回顾性诊疗费用支付模式。出院后90天内的所有相关护理都将纳入诊疗过程。我们相信,这些模式将进一步推动我们的目标,即提高接受这些常见临床病症和手术治疗的医疗保险受益人的护理效率和质量。

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