Table 4.

Core Features of the Mandatory Acute Myocardial Infarction Episode Payment Model

Characteristic	Features	Comment
Condition	Acute myocardial infarction: medical management (MS-DRG 280- 282); interventional management (MS-DRG 246–251)	Intracardiac procedures and CABG are excluded
Participants	All hospitals located in 98 randomly selected metropolitan statistical areas	Selected rural hospitals and current BPCI participants are excluded
Payment model	Bundled payment: admission through 90 d after discharge; 2-sided risk model; and retrospective reconciliation	All inpatient and outpatient Medicare charges are included
Bundle amount	Payment determined by medical vs interventional management; blend of own historical spending and regional spending; and quality performance	Minimum quality score required for payment. Payment shifts toward regionally determined rates over time
Amount at risk	Year 1 gain: 5% and loss: none; Year 2 gain: 5% and loss: 5%; Year 3 gain: 10% and loss: 10%; Year 4 gain: 20% and loss: 20%; Year 5 gain: 20% and loss: 20%	Financial risk is limited for selected rural hospitals
Quality metrics	Composite quality score: hospital 30 d, all-cause risk-standardized mortality; excess days in acute care after hospitalization; Hospital Consumer Assessment of Healthcare Clinicians and Systems Survey; and voluntary hybrid hospital 30-d, all-cause risk-standardized mortality rate	Each measure requires a minimum No. of cases

Abbreviations: BPCI, Bundled Payments for Care Improvement Initiative; CABG, coronary artery bypass grafting; MS-DRG, Medicare Severity Diagnosis-Related Group.