HHS’s Price Urges Doctors to Submit Ideas for Medicare Pay Models

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By Mindy Yochelson

Doctors should step up and recommend more payment alternatives to fee-for-service Medicare, the HHS secretary said April 11.

Health and Human Services Secretary Tom Price said innovative payment models could work better than fee-for-service Medicare and might stop doctors from leaving the profession at middle age because they feel “burned out.”

Price, a third-generation doctor, spoke before the first voting meeting of the Physician-Focused Payment Model Technical Advisory Committee, created by a 2015 law to consider and recommend alternative payment models that would hold clinicians accountable for cost and quality of care. The innovative physician-focused payment models being considered by the committee are intended to move doctors away from the traditional pay system.

Rather than encouraging simply a high volume of services, the models are intended to offer a payment approach that can give doctors added incentive payments to offer coordinated and cost-efficient care in a collaborative setting.

One Size Fits All?

Price said part of the burnout problem is the “one size fits all” Medicare model they must work under.

Doctors across the country should offer the committee ideas about what payment model would work better for them, the HHS secretary said. This is especially important for those in rural and underserved areas who think the current system is designed for large integrated groups that have administrative assistance, he said.

Price praised the half dozen groups that submitted models for the committee to decide whether to recommend for approval to the HHS.

The technical committee was created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a law that replaced Medicare’s sustainable growth rate formula.

MACRA offers medical professionals a payment system with two options—continue being paid under the Medicare fee-for-service system and be graded by quality measures that could result in payment cuts, or join an advanced alternative payment model (APM). Those who join an HHS-approved advanced APM are protected from cuts they might receive under the quality grading program and are eligible to receive a 5 percent bonus on their reimbursements.

Model Rejected

The 11 members of the technical panel rejected one of the models that was submitted and recommended limited testing for two others.

Members said that a model submitted by the Pulmonary Medicine, Infectious Disease and Critical Care Consultants Medical Group Inc. of Sacramento, Calif., failed on two of 10 categories the panel uses to review ideas.

The Chronic Obstructive Pulmonary Disease (COPD) and Asthma Monitoring Project would have used such tools as “smart alarms” and a “panic button” to monitor patients’ disease and medication adherence through a smart phone application.

However, members said it didn’t measure up on committee criteria for integration and care coordination and payment methodology.

More Testing Required

Two other models will be recommended to the HHS for limited-scale testing.

Project Sonar, submitted by Illinois Gastroenterology Group, is a care management program intended to improve the medical management of those with chronic disease, in part to reduce the cost of care. Some of the methods include assessing all patients using a “set of biopsychosocial measures,” and enrolling them in a “web-based communication platform,” such as through smart phones.

“We intentionally requested limited scale testing,” Lawrence R. Kosinski, managing partner of the Illinois Gastroenterology Group, told Bloomberg BNA April 11. “Our model has been implemented in patients” with inflammatory bowel disease, he said. “In order to fully deploy it, we need some limited scale testing in other chronic conditions,” he said.

The other model recommended for limited testing is from the American College of Surgeons-Brandeis Advanced APM. This model uses episodes of care to measure savings and losses and adjusts payment based on quality of care.

To contact the reporter on this story: Mindy Yochelson in Washington at MYochelson@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

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