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The Centers for Medicare & Medicaid Services a new payment model that will bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services beginning in July 2017. The rule also will expand the existing Comprehensive Care for Joint Replacement model to include other surgical treatments for hip and femur fractures beyond hip replacement. Under both the new cardiac bundled payment model and the expanded CJR model, the hospital in which the initial services are provided will be held accountable for the quality and costs of care for the entire episode of care from the time of the hospital stay through 90 days after discharge. The hospital will either earn a financial reward or be required to repay Medicare for a portion of the costs based on its performance on cost and quality for the episode. The cardiac model will be mandatory for hospitals in . For more, see the . "While we are pleased they made some improvement to the programs, such as flexibility on risk adjustment and MACRA participation, we remain very concerned about several key issues, particularly the pace of change,” said Tom Nickels, AHA executive vice president of government relations and public policy. “The bundled payment model for cardiac care is the second mandatory demonstration project the agency has finalized in just the past 15 months. This is too much, too soon. Regrettably, at the same time, the agency finalized its plans to expand and further complicate its existing mandatory hip and knee bundled payment model less than a year after it began, and before fully evaluating its results.” AHA members will receive a Special Bulletin with further details soon.