CMS Patrick Conway M.D, Acting Principal Deputy Administrator for Innovation and Quality, and Chief Medical Officer for CMS www.cms.gov, met with reporters at a National Press Club briefing held May 4, 2016. The event’s discussion on delivery system reforms as related to Medicare was led by Marilyn Serafini, President & Co-CEO of the Alliance for Health Reform www.allhealth.org.
Medical homes, ACOs, and bundled payment models combined account for care provided to about 10 million Medicare beneficiaries. Within these delivery system reforms, CMS is currently managing multiple payment models.
Dr. Conway said, “CMS is working with the medical community to advance the vision for Medicare payment reform. By proposing a flexible rather than a one size fits all program, we are attempting to give doctors and other clinicians the opportunity to participate in a way that is best for them, their practice, and their patients.”
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is going to make comprehensive changes as to how Medicare pays for physician services. As Conroy explained, “The legislation stops the SGR formula, creates a framework to reward providers for giving better care not just more care, and combines existing quality reporting programs into one new system.”
Conway reported,, “MACRA replaces the SGR with annual 0.5 percent payment increases for each of the next five years and give providers two payment track options such as “Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).”
On April 27, 2016, HHS www.hhs.gov issued a Notice of Proposed Rulemaking to implement key provisions of MACRA. The proposed rule would implement changes through MIPS and APMs and has bipartisan support.
In addition, the transformation of primary care includes the Comprehensive Primary Care Initiative (CPC) along with CPC+. In 2011, the CMS Center for Innovation Programs (CMMI) https://innovation.coms.gov announced CPC where private payers and state Medicaid Programs partner with Medicare to invest in primary care.
The CPC+ program recently announced enables primary care practices to apply to participate but all CPC+ practices must demonstrate multi-payer support. Practices will be required to use and expected to report electronic clinical quality measures at the practice level. Vendors are set to develop and optimize a set of health IT functions that will work in practices.
CPC+ is a five year model that will begin in 2017. It is expected that the model will partner with commercial and state payers in up to 20 regions around the country to support primary care practices.
As for the CMMI Bundled Payment Models, the goal is to provide better coordinated care. CMMI has been testing four models with each model incorporating a somewhat different set of services and payment arrangements.
One of the bundled models due to start July 1, 2016, is called the “Oncology Care Model”. Physician practices will receive fee-for-service payments, monthly per beneficiary care management fees, and shared savings payments for reducing total Medicare spending on oncology patients.
Reporters asked Dr. Conway several questions concerning the new Medicare Part B prescription drug models. Right now, Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug plus a 6 percent add-on.
The proposed model would test whether changing the add-on payment to 2.5 percent plus a flat fee payment of $16.00 per drug per day would change prescribing incentives and lead to improved quality and value. CMS would update the flat fee at the beginning of each year by the percentage increase in the consumer price index for medical care for the most recent 12 month period.