The roller coaster of value-based payment continued its thrill ride in 2016.
The CMS Innovation Center took a controversial plunge into mandatory pilots with the start of its bundled-payment program for hip and knee replacements. It kept up the momentum by proposing mandatory cardiac bundles and an experiment with payment formulas for drugs administered in a doctor’s office or hospital outpatient department.
It’s widely expected that President-elect Donald Trump’s pick for HHS secretary, Rep. Tom Price of Georgia, would roll back these programs even if he otherwise maintains the Innovation Center and its work. Federal data on Medicare’s value-based purchasing program for hospitals, meanwhile, suggested it is having little impact on hospital performance.
CMS officials spent much of the year hammering out the regulations for the Medicare Access and CHIP Reauthorization Act, which ties fee-for-service reimbursement to quality and efficiency measures and encourages physicians to adopt alternative payment models.
The agency ultimately made a number of concessions to help the industry adjust to MACRA and also created new opportunities for providers to participate in riskbased models. The final rule made about a third of U.S. physicians exempt from its requirements.
“NO (QUALITY) MEASURE IS EVER PERFECT. IT’S NEVER PERFECTLY FAIR TO ALL PROVIDERS UNDER ANY CIRCUMSTANCES. IT’S JUST IMPOSSIBLE.” Leah Binder, CEO of the Leapfrog Group