News: AHA, other provider groups call for transparency in future CMS payment models

At the end of September, CMS called for input on the CMS Innovation Center’s future. The Innovation Center is tasked with testing new payment and delivery models to reduce healthcare spending while improving patient care, according to their website. CMS accepted comments through November 20. 

While critics said the move was intended to undermine Medicare, according to Fierce Healthcare, many provider groups still submitted comments. As in most cases, the American Hospital Association (AHA) was one such group.

The AHA urged CMS to build future payment models on transparency, allowing participants to make informed decisions. Additionally, the letter said that risk and reward need to be balanced in the measures in such a way that encourages providers to take on more risk without being unfair.

In their letter, the AHA outlined 10 principals (including the two mentioned above) it believes should be applied by the Innovation Center. One suggestion of particular note for CDI is that “models should include adequate risk adjustment methodologies to ensure they do not inappropriately penalize participants treating the sickest, most complicated, and most vulnerable patients.”

The Center for Healthcare Quality & Payment Reform also added their voice to the discussion in a report outlining ways CMS could improve the Innovation Center’s approach to testing and developing payment models, according to Fierce Healthcare.

The report called for four specific modifications: 

• A “bottom-up” approach to payment reform, which would mandate CMS’ participation in alternative payment models developed locally by physician groups and hospitals
• Support of multiple payment models at once because there’s no one-size-fits-all for payment reform
• “Limited scale testing” to speed up implementation because the current process will prohibit many models from being tested at all
• A redesigned process for testing and implementing models

Editor’s note: To read Fierce Healthcare’s coverage of this topic, click here. To read the AHA’s letter to CMS, click here. To read the report from the Center for Healthcare Quality & Payment Reform, click here.