HHS is the biggest purchaser of health care in the United States, through its Medicare program, which provides coverage for primarily senior citizens, and the Medicaid program, which provides coverage to mainly poor people with federal and state funds.
"Having a heart attack or undergoing heart surgery is scary and stressful for patients and their families," said HHS Secretary Sylvia Burwell.
"Today's proposal is an important step to improving the quality of care Americans receive and driving down costs. By focusing on episodes of care and rewarding successful recoveries, bundled payments encourage hospitals to coordinate care to achieve the best outcomes possible for patients."
Dr. Patrick Conway, acting principal deputy administrator of the federal Centers for Medicare and Medicaid Services, a division of HHS, said the current way that Medicare pays for cardiac care by hospitals has led to "variations in cost and quality of care at different hospitals."
HHS noted that more than 200,000 Medicare beneficiaries were in hospitals in 2014 for either heart attack treatment or bypass surgery, costing Medicare more than $6 billion. But the costs of surgery, hospitalization and recovery for bypass patients "varied by 50 percent across hospitals," and the share of heart attack patients readmitted to the hospital within 30 days varied by more than 50 percent, HHS said.
The proposed bundled-payment model for cardiac care would be phased in over a period of five years, but would start July 1, 2017, for hospitals in 98 metropolitan areas, which comprise about one-fourth of all U.S. metro areas.
"Under the new models in today's rules, the hospital in which a Medicare patient is admitted for care for a heart attack or bypass surgery would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries during the in-patient stay and for 90 days after discharge," HHS said.
The bundled payment model for hip and femur fractures would be phased in starting with the 67 metro areas whose 800 or so hospitals already are receiving bundled Medicare payments for hip replacements.
Conway said that HHS has already seen "promising results" from voluntary bundled payment models it now has with more than 1,500 hospitals and physicians groups.