Centers for Medicare & Medicaid Innovation
Created as part of the Affordable Care Act, the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) supports the development and testing of health care payment and service delivery models.
Federation of American Hospitals (FAH) members are active participants in many of CMMI’s current demonstrations including the Comprehensive Care for Joint Replacement (CJR) model, the Bundled Payments for Care Improvement (BPCI) initiative, the Medicare Shared Savings Program (MSSP) and a number of CMMI’s other Accountable Care Organization (ACO) models.
FAH and its members are strong proponents of exploring innovations that could lead to improvements in health care delivery and payment and believe that CMS should adopt four key principles to guide CMMI’s agenda and mission:
- Reasonable limits on testing
- Reaffirm Congress’ role in expansion
- Transparency and stakeholder engagement
- Data sharing
Along these lines, FAH advocates for a number of specific improvements to how CMMI develops and implements models:
- Voluntary Models: The FAH strongly believes that all CMMI models should only be implemented on a voluntary basis as the statute does not authorize CMS to mandate provider participation in any CMMI models.
- Small-Scale Models: CMS has undertaken national, mandatory models that run afoul of the intent of the law. Such models deprive Congress of its authority to review the results of CMMI models and make decisions about whether those results warrant a broader expansion. Given that CMMI is tasked with testing payment models that are considerably different than Medicare’s current payment structure, it is imperative that CMS understand the impacts of those changes prior to seeking to advance them more broadly.
- Transparent Model Design: CMS should solicit robust public input prior to and during model development. Additionally, where appropriate, CMS should engage in formal public notice and comment rulemaking. The changes being tested and advanced by CMS impact the way care is delivered and paid for and as such, it is important that CMS avail itself of all available, relevant information while developing its models.
- Appropriate Program Exceptions: The health care program integrity regime has not kept pace and was designed to keep hospitals and physicians and other providers in silos, rather than working in alignment as a team, which is necessary for success in CMMI’s models. To truly effectuate change, the hospital community must be afforded the flexibility to align physicians’ (as well as other providers’) otherwise divergent financial interests, while promoting incentives to reduce costs and improve quality. To that end, in November 2020, CMS and the Office of Inspector General (OIG) issued physician self-referral and Medicare anti-kickback final rules, respectively, in large part to modernize and create exceptions under these laws as they apply to CMMI payment and delivery models. CMS should continue its work with the (OIG) to ensure these rules are applied appropriately and fairly.
- Timely Availability of Accurate Data Needed to Properly Manage Care and Monitor Performance: Hospitals must be given the tools needed to manage patient care and achieve program goals. It is critical that hospitals receive relevant and timely data, be permitted enough time to analyze the data, and take appropriate action with participant partners on a timely basis. The data must be provided prior to the start of any new model, and at regular intervals (e.g., monthly) throughout the model.
- Appropriate Quality Measurement: Measuring quality is an integral part of all CMMI models and is a key component of a potential expansion of a successful model. CMS should carefully evaluate the quality measures proposed and used in each model to ensure that the measures selected fit the purpose of the demonstration.