House GOP tells CMS to stop manda­tory in­volve­ment in pay­ment re­form pro­posal

Modern Healthcare - - LATE NEWS - —Shan­non Much­more

House Repub­li­cans want the CMS to stop rolling out new manda­tory pay­ment mod­els they say threaten qual­ity of care and over­step the agency’s author­ity.

In a let­ter to act­ing CMS Ad­min­is­tra­tor Andy Slavitt and Chief Med­i­cal Of­fi­cer Dr. Pa­trick Con­way, the 179 mem­bers of the House say the Cen­ter for Medi­care and Med­i­caid In­no­va­tion has “ex­ceeded its author­ity” and “pa­tients are blindly be­ing forced into high-risk gov­ern­ment-dic­tated re­forms with un­known im­pacts.”

The let­ter tar­gets 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.

Law­mak­ers and provider groups say more time is needed to re­view the pro­pos­als.

In a state­ment last week, the CEO of the Med­i­cal Group Man­age­ment As­so­ci­a­tion said the group wants more alternative pay­ment mod­els but agrees with the GOP law­mak­ers.

“In­stead of a purely top-down gov­ern­ment ap­proach, CMMI should also adopt proven pri­vate-sec­tor ini­tia­tives that ad­vance Medi­care’s goal to pro­vide high-qual­ity, cost-ef­fec­tive pa­tient care,” Dr. Halee Fis­cher-Wright wrote.

The con­gres­sional 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 it.

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 have had suc­cess in re­duc­ing costs and im­prov­ing pa­tient out­comes.

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