Lawmakers to CMS: CMMI Has Overstepped Its Authority | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Lawmakers to CMS: CMMI Has Overstepped Its Authority

September 30, 2016
by Heather Landi
| Reprints

Close to 200 federal lawmakers sent a letter to Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS) calling out the Center for Medicare and Medicaid Innovation (CMMI) for overstepping its authority by proposing mandatory healthcare payment and service delivery models.

CMMI is charged with piloting, testing and evaluating alternative payment models with the intent of increasing quality and efficiency, while reducing program expenditures under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Congressmen Tom Price, M.D., Charles Boustany, M.D., and Erik Paulsen wrote a letter to CMS, which was signed by 179 members of Congress, stating that three recently proposed mandatory models  demonstrate that CMMI has “exceeded its authority, failed to engage stakeholders and has upset the balance of power between the legislative and executive branches.”

In the letter, the legislators state that the proposals would negatively impact patients. "We ask that your cease all current and future planned mandatory initiatives under the CMMI,” the legislators wrote.

The Medical Group Management Association (MGMA) issued a public statement supporting Congressmen Price, Boustany and Paulsen and their efforts to provider oversight of CMMI.

“In a recent letter to the Centers for Medicare and Medicaid Service, 179 members of Congress highlighted CMMI’s overreach of its authority by rolling out mandatory, experimental demonstrations, which impact physician practices and Medicare patients across the nation. MGMA supports these members of Congress as they remind CMMI of its specific statutory role in facilitating the transition from fee-for-service to value-based payment arrangements,” MGMA president and chief executive officer, Halee Fischer-Wright, M.D. wrote.

 The members of Congress state that until recently the tests and models developed by CMMI were implemented on a voluntary, limited-scale basis where “no state, healthcare provider or health insurer had any obligation to participate.”

The letter specifically cites 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 cite 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 state 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.” “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’,” the legislators wrote. And the legislators assert that some models tested under demonstration programs failed to produce quality improvements and anticipated cost savings. And, the legislators contend that patients have no choice about their participating in these models.

The lawmakers also contend CMS’ Part B proposal would “rewrite Medicare Part B payment law in 75 percent of the country without going through the Constitutional procedures where legislation is debated and approved by both chambers of Congress, and subsequently signed by the President.”

Fischer-Wright with MGMA wrote in the organization’s public statement, “CMMI must engage in an open and transparent process that incorporates physician input to develop and evaluate new APMs prior to mandatory implementation. 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.”

In conclusion, the legislators called for CMS to “cease all current and future planned mandatory initiatives within the CMMI.” “Additionally, we ask that you commit to ensuring future CMMI models fully comply with current law, including: limiting the size and scope of CMMI demonstrations so they represent true tests rather than wholesale changes to statute; seeking Congressional approval if expansion of test models require changes to the underlying statute; and establishing an open, transparent process that supports clear and consistent communication with physicians and other relevant stakeholders in the development of new CMMI models.”

 

 

 

Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More

Topics

News

Healthcare Execs Anticipate High Cost Returns from Predictive Analytics Use

Healthcare executives are dedicating budget to predictive analytics, and are forecasting significant cost savings in return, according to new research from the Illinois-based Society of Actuaries.

Adam Boehler Tapped by Azar to Serve as Senior Value-Based Care Advisor

Adam Boehler, currently director of CMMI, has also been named the senior advisor for value-based transformation and innovation, HHS Secretary Alex Azar announced.

Vivli Launches Clinical Research Data-Sharing Platform

On July 19 a new global data-sharing and analytics platform called Vivli was unveiled. The nonprofit group’s mission is to promote, coordinate and facilitate scientific sharing and reuse of clinical research data.

Survey: More Effective IT Needed to Improve Patient Safety

In a Health Catalyst survey, physicians, nurses and healthcare executives said ineffective information technology, and the lack of real-time warnings for possible harm events, are key obstacles to achieving their organizations' patient safety goals.

Physicians Still Reluctant to Embrace Virtual Tech, Survey Finds

While consumers and physicians agree that virtual healthcare holds great promise for transforming care delivery, physicians still remain reluctant to embrace the technologies, according to a new Deloitte Center for Health Solutions survey.

Geisinger, AstraZeneca Partner on Asthma App Suite

Geisinger has partnered with pharmaceutical company AstraZeneca to create a suite of products that integrate into the electronic health record and engage asthma patients and their providers in co-managing the disease.