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October 11, 2016



Legislators Write to CMS on Mandatory Initiatives, MACRA

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Legislators Write to CMS on Mandatory Initiatives, MACRA

Three prominent members of the House of Representatives recently organized a letter to the Centers for Medicare & Medicaid Services (CMS) stating opposition to current and future planned mandatory initiatives within the Center for Medicare and Medicaid Innovation (CMMI). In the letter, which was signed by 179 members of Congress, House Ways & Means Committee Member and Budget Committee Chairman Tom Price, MD (R-GA), House Ways & Means Committee Member Charles Boustany Jr., MD (R-LA), and House Ways & Means Committee Member Erik Paulsen (R-MN) contended that CMMI overstepped its legislative authority by implementing compulsory, nationwide alternative payment models without congressional approval. They also asserted the federal agency neglected to gather stakeholder feedback on the three compulsory alternative payment models, and failed to determine if the large-scale programs would maintain or improve quality of care.

Legislators note in the letter that until recently, CMMI tested payment reform models on a voluntary basis, and no state, provider, or payer was required to participate. But in November 2015, CMS released the final rule on the Comprehensive Care for Joint Replacement (CJR) model, which required at least 800 hospitals in 67 geographical areas to take part in Medicare bundled payments for hip and knee replacements. In 2016, the legislators added, CMS proposed the Part B Drug Payment program, which would reimburse Medicare providers for prescription drugs under an alternative payment model, and the Cardiac Bundled Payment model that would require one-quarter of all metropolitan areas to participate in bundled payments for certain cardiac episodes as well as expand the CJR Model to include more hip episodes. The letter asks CMS to 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, patients and other relevant stakeholders in the development of new CMMI models.

“We insist CMMI stop experimenting with Americans’ health, and cease all current and future planned mandatory initiatives within the CMMI,” the letter states. 

Read the full congressional letter online here.

AAOS has expressed similar concerns in recent comments to CMS, stating that the mandatory nature of these models will force into a bundled payment system many surgeons and facilities who lack the familiarity, experience, or proper infrastructure to support care redesign efforts, which may lead to care that is not as cost-effective as anticipated. AAOS also noted that the CJR model could severely disadvantage those surgeons, non-physician providers, and facilities that either do not have the proper infrastructure to optimize patient care under episodes-of-care payment models and/or lack adequate patient volumes to create sufficient economies of scale. Most recently, AAOS submitted a letter for the record emphasizing these concerns to Congress. Read the full letter online here.

In addition to the CMMI letter, the GOP Doctors Caucus recently sent a letter to CMS acting administrator Andy Slavitt and OMB Director Shaun Donovan calling for less burdensome, more flexible reporting schemes for doctors in the impending MACRA final rule. Legislators call for a 90-day, rather than a year-long reporting period, and lower reporting thresholds for small and rural practices.

“I applaud the administrator on the steps he’s taken to make himself available to hear concerns from members of the GOP Doctors Caucus and other providers, and to address some of the concerns related to the proposed January 1, 2017 implementation date,” Rep. Phil Roe, MD (R-TN) said in a statement. “However, I am still concerned about the potential unintended consequences of implementing these changes so quickly.”

Read the full MACRA letter online here.

Visit the AAOS MACRA resource page for all materials and updates: