House Republicans are asking the CMS to stop new mandatory payment models they say threaten quality of care and overstep the agency's bounds.
to CMS Acting Administrator Andy Slavitt and Chief Medical Officer Patrick Conway, the 179 members of the House say the Centers for Medicare and Medicaid Innovation has “exceeded its authority” and “patients are blindly being forced into high-risk government-dictated reforms with unknown impacts.”
Lawmakers and provider groups have advocated at least delaying the new payment models, saying more time is needed to review the proposals. Republicans in the House have also said the Congressional Budget Office may be biased in evaluating the CMMI proposals.
In a statement Friday, the president and CEO of the Medical Group Management Association said the group advocates for more alternative payment models but agrees with the lawmakers.
“CMMI must engage in an open and transparent process that incorporates physician input to develop and evaluate new APMs prior to mandatory implementation,” Dr. Halee Fischer-Wright wrote. “Instead of a purely top-down government approach, CMMI should also adopt proven private sector initiatives that advance Medicare's goal to provide highly quality, cost-effective patient care.”
The letter is spearheaded by Reps. Tom Price of Georgia, Charles Boustany of Louisiana and Erik Paulsen of Minnesota. One Democrat, Rep. Brad Ashford of Nebraska, also signed.
The letter specifically mentions two bundled payment models -- the Comprehensive Care Joint Replacement Model and the Cardiac Bundled Payment Model. They also cite the Part B Drug Payment Model, which changes the way doctors are reimbursed for outpatient drugs.
The joint replacement bundled model involves about 800 hospitals in 67 geographical areas while the cardiac bundled model is mandated for about one-fourth of all metropolitan areas in the country. The Part B change is required for all providers and suppliers billing for Part B, although some will first be in a control group using the old model as a way to compare outcomes. Providers say they are being asked to start the programs before they have time to get ready.
Bundled payments involve setting one price per patient per episode of care and are one of the more popular options in the growing movement toward value-based payment in healthcare. Studies have shown mixed results but some success in reducing payment and improving patient outcomes.
Topher Spiro, vice president of health policy at the Center for American Progress, said in an email that he believes the letter won't have much impact.
“That the Republicans dislike CMMI and the Affordable Care Act is not a surprise,” he wrote. “Sending a letter won't do anything to change the direction or focus of payment reform to lower health care costs.”
Anne Wong, a director at PwC in its healthcare advisory practice, said the CMS proposals have flaws, but without mandated participation, it could be difficult to push for change and see the improvement bundled payment models can make. Providers may need more time to prepare for relatively drastic changes.
“In order for bundles to be successful, we need to see them happen in a much bigger way than they are today,” she said.
Francois de Brantes, executive director of the Health Care Incentives Improvement Institute, said the letter is an appropriate response to the CMS pushing alternative payment models too quickly and without acting on voluminous feedback from stakeholders.
There is no reason to move as quickly as the CMS has because the movement toward value-based payment will continue regardless of who is in the White House, he said.
“To date, they (the CMS) simply have just chosen to ignore that feedback favoring speed over design adequacy,” Brantes said.
Brantes said politicians on both sides of the aisle have demonstrated support for value-based payments, so the CMS will be able to continue that work regardless of who wins the election.