The alternative payment models (APMs) of CMS Innovation Center resulted in value-based care success and will be important for continuing MACRA implementation, a CMS leader claimed.
Acceding to a recent blog post, CMS Acting Principal Deputy Administrator Patrick Conway, MD, mentioned the federal agency’s Innovation Center’s victories with alternative payment model development, particularly as MACRA implementation continues.
Conway wrote, “Today, based on the victorious work of the CMS Innovation Center and countless public and private sector partners, we can now claim that healthcare delivery system reform dealing both quality and cost has become part of the fabric of Medicare, Medicaid, and the healthcare sector nationwide.”
Recently, the Congressional Budget Office projected that CMS Innovation Center initiatives would decrease the federal healthcare spending by over $34 billion between the time period of 2017 and 2026.
But the center could confront elimination or less funding if the Affordable Care Act (ACA) is repealed under the upcoming Trump Administration. Few policymakers have already condemned the CMS Innovation Center for overstepping its authoritative power, involving President-Elect Trump’s pick for Department of Health and Human Services (HHS) Secretary Representative Tom Price (R-GA).
Price and 2 other representatives penned a letter to CMS in September 2016 describing how the federal agency can’t implement compulsory, nationwide alternative payment models, like the Comprehensive Care for Joint Replacement and cardiac care bundled payment programs, without Congressional approval.
With the CMS Innovation Center potentially on the chopping block, Conway mentioned how the center is key to MACRA implementation success similar to CMS Acting Administrator Andy Slavitt’s comments in the year of December 2016.
According to Conway, the CMS Innovation Center is the “mechanism to create new Advanced Alternative Payment Models in the future,” while Slavitt claimed that “MACRA cannot work as well without a CMS Innovation Center that can move rapidly to develop and expand new approaches to paying for care.”
MACRA consists of Advanced Alternative Payment Model track that qualifying eligible clinicians can use to earn a 5% value-based incentive payment in the year of 2019. Eligible clinicians must participate in an approved alternative payment model (APM) to qualify, but merely 8 are presently approved for the 2017 performance year.
Several healthcare industry groups expressed disappointment with restricted Advanced Alternative Payment Model choices when the final MACRA implementation rule debuted in the month of October 2016. For instance, Tom Nickels, the American Hospital Association Executive Vice President, voiced concern “that CMS sustains to narrowly define Advanced Alternative Payment Models, which means that less than 10% of clinicians will be rewarded for their care transformation attempts.”
A healthcare improvement company, Premier Inc., also argued that approved Advanced Alternative Payment Model options for 2017 consisted of too much financial risk, which would limit participation.
Conway, although, touted that the CMS Innovation Center recently expanded Advanced Alternative Payment Model options. In addition to re-opening Comprehensive Primary Care Plus and Next Generation Accountable Care Organization model applications for 2018 participation, the center also unveiled 5 new alternative payment models, involving cardiac and orthopedic care bundled payment programs. The center also established the Medicare Shared Savings Program (MSSP) Track 1+, which consists of less financial risk than other MSSP tracks.
With more choices and options, CMS projects between the 125,000 and 250,000 eligible clinicians to participate in an Advanced Alternative Payment Model by the year of 2018.
The CMS leader also attributed broader value-based care transition victory to the Innovation Center.
CMS is also on track to hit its target of linking 50% of Medicare payments to alternative payment models, several established by the Innovation Center, by the end of 2018.
Conway also claimed that CMS will sustain to make better the stakeholder engagement and assess demonstration results.
He concluded, “Together we can continue to strive to acquire better care, healthier people, and smarter spending.”
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