In a report to Congress, the Center for Medicare and Medicaid Innovation (CMMI, or the CMS Innovation Center) touted its accomplishments over the past six years as it relates to healthcare delivery system reform.
According to a blog post from Patrick Conway, M.D., acting principal deputy administrator and deputy administrator for innovation and quality, Centers for Medicare & Medicaid Services (CMS), “Since opening its doors in late 2010, the CMS Innovation Center has worked to enhance the quality of healthcare delivered while not increasing costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. The CMS Innovation Center takes locally-driven approaches—approaches from doctors and other health care partners providing care to patients every day—and gives them the platform to be tested through a collaborative process.”
The post continued, “Today, based on the successful work of the CMS Innovation Center and countless public and private sector partners, we can now say that healthcare delivery system reform addressing both quality and cost has become part of the fabric of Medicare, Medicaid, and the health care sector nationwide.” Specifically, the report to Congress, prepared by the CMS Innovation Center, touted achievements of the department including:
- Over 30 new payment models launched over the past six years
- Investments in electronic medical records and a data and analytics infrastructure which are sparking a new set of innovative companies.
- The CMS Innovation Center’s portfolio of models has attracted participation from a broad array of healthcare providers, states, payers, and other partners. An estimated 18 million individuals, including CMS beneficiaries and individuals with private insurance included in multi-payer models, have been impacted by, have received care, or will soon be receiving care furnished by more than 207,000 healthcare providers participating in CMS Innovation Center payment and service delivery models and initiatives. These models are delivering care to people in every state across the nation.
- Medicare exceeded—earlier than predicted—the goal to tie more than 30 percent of fee-for-service payments by the end of 2016 through alternative payment models to quality and cost metrics. Medicare is on pace to reach 50 percent by the end of 2018.
What’s more, since the passage of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the CMS Innovation Center has been at the core of its implementation. The Quality Payment Program, which implements provisions of MACRA, includes a five percent incentive payment for physicians and other clinicians sufficiently participating in Advanced Alternative Payment Models, APMs. (The CMS Innovation Center is the mechanism to create new Advanced Alternative Payment Models in the future, Conway stated.) In fact, the CMS Innovation Center has recently announced more than five new or re-opened opportunities for clinicians to join Advanced Alternative Payment Models. CMS expects 125,000 to 250,000 clinicians to be participating in Advanced Alternative Payment Models by 2018.
What’s to Come?
The report from the CMS Innovation Center comes at an interesting time, as the center has been questioned in the past by House Republicans for overstepping its definition in statutes. Now, with President-elect Trump set to take over the White House, with a Republican-controlled Congress to boot, the future of CMMI is undoubtedly in question. The CMMI was established as an added section under President Obama’s Affordable Care Act (ACA).
As Healthcare Informatics previously reported, “Expected new HHS Secretary, Congressmen Tom Price, M.D (R-GA), headed a letter to CMS in September questioning the Center for Medicare and Medicaid Innovation for overstepping its authority by proposing mandatory healthcare payment and service delivery models.”
The letter at the time specifically cited the CMS final rule requiring at least 800 hospitals in 67 geographical areas selected by CMS to participate in a new bundled payment model for hip and knee replacements, the Comprehensive Care Joint Replacement (CJR) Model, as well as a proposed rule requiring thousands of providers to comply with a new drug payment model under Part B of Medicare (the Part B Drug Payment Model). In addition, the legislators also cited the cardiac bundled payment model CMS announced in July that requires some providers to participate in bundled payments for certain cardiac conditions as well as expansion of the CJR model.
The legislators stated in the letter that the CMMI models were developed without input from impacted stakeholders and fail to include safeguards to protect the “delicate balance of quality, cost and access to care for beneficiaries.” It continued, “CMS at best has heeded only part of its statutory duty—‘reducing program expenditures’—at the expense of its other duties—‘preserving or enhancing the quality care.’” And, the legislators asserted that some models tested under demonstration programs failed to produce quality improvements and anticipated cost savings. Further, the legislators contended that patients have no choice about their participating in these models.
In the letter, Price and other legislators stated that these models would negatively impact patients. "We ask that your cease all current and future planned mandatory initiatives under the CMMI,” the legislators wrote in September.
Nonetheless, federal officials last month moved forward with finalizing new Medicare alternative payment models around cardiac and orthopedic care, as well as the agency’s Medicare accountable care organization (ACO) Track 1+ Model—some of the very models that Price and others have called into question.
Moving forward, the CMMI report to Congress also noted how the Innovation Center has partnered with Medicare, Medicaid, and private health plans in the commercial market on new models of care and innovation, with a number of initiatives set to come to more beneficiaries over the next few years. Some of these include:
- Three new payment models—the Acute Myocardial Infarction Model, the Coronary Artery Bypass Graft Model, and the Cardiac Rehabilitation Incentive Payment Model—will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation.
- Through the Comprehensive Primary Care Plus Model, primary care doctors can care for their patients the way they think will deliver the best outcomes, and they’ll get paid for achieving results and improving care.
- One new payment model—the Surgical Hip and Femur Fracture Treatment Model—will support clinicians in providing care to patients who undergo surgery after a hip or femur fracture beyond hip replacement. In addition, we finalized updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.
- The Accountable Health Communities Model, beginning in 2017, will test whether increased awareness of and access to services addressing health-related social needs will impact total health care costs and improve health and quality of care for Medicare and Medicaid beneficiaries in selected communities. This model will address a critical gap between clinical care and community services in the current delivery system.
Conway’s blog post concluded, “After more than six years, the healthcare system is objectively safer while making Medicare more financially secure for future generations. Such significant progress is possible because we have worked with Congress and stakeholders to listen, adapt, and advance proven ideas.”