The Center for Medicare and Medicaid Innovation (CMMI), which develops concepts for healthcare payment and service delivery, must be transparent and engaged with all stakeholders as it tests new models, according to a coalition of 30 associations.
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On Feb. 10, the Healthcare Leaders for Accountable Innovation in Medicare Coalition, which includes the ACR, released six guiding principles it hopes the CMMI will adopt as it moves forward with testing. The CMMI develops and tests innovative healthcare models and plays an important role in the Quality Payment Program element of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The CMMI is developing Advanced Alternative Payment Models (APMs), and the ACR is currently exploring the creation of rheumatology-focused APM models.
The Guiding Principles
The ACR and its coalition partners urge the CMMI to:
- Foster strong, scientifically valid testing of experiments prior to expansion and ensure that participation in all model tests be voluntary;
- Respect the role of Congress in making health policy changes, including approval of model expansions and any related changes to Medicare and Medicaid;
- Consistently provide transparency and meaningful stakeholder engagement as it develops, tests and expands models;
- Improve data sharing from these tests and release results to the public, so the impact on care quality and costs may be assessed;
- Strengthen beneficiary safeguards so patients are adequately educated about new demonstration tests; and
- Collaborate with the private sector to facilitate competitiveness and innovation as it tests new models for healthcare quality and cost efficiency of care.
“These principles will go a long way toward focusing the important work of the CMMI on appropriately scaled projects that align Medicare payment structures with our patients’ healthcare needs,” says Angus B. Worthing, MD, FACP, FACR, a practicing rheumatologist at Arthritis & Rheumatism Associates, PC, in Washington, D.C., and the chair of the ACR’s Government Affairs Committee. “The ACR supports fully transparent, innovative, data-driven ways to make healthcare more valuable and accessible to our patients.”
CMMI & Medicare Part B
The CMMI’s various initiatives include the design and study of accountable care organization models and speeding the adoption of evidence-based best practices in healthcare. However, some recent actions, such as its Medicare Part B Demonstration Project, are examples of overreach, says Dr. Worthing. The Part B Drug Payment Demonstration proposed to cut already-thin reimbursements to doctors, not to drug companies, to reduce overall spending on Part B drugs, such as biologics.
“After considerable advocacy on our part and that of a large coalition, the demonstration was not implemented. We do agree that the extremely high costs of biologics need to be addressed, but an essentially nationwide CMMI project was too broad in scope, and a foundational assumption—that there are less expensive, equally effective alternative therapies available for prescribers—was not applicable to rheumatology,” says Dr. Worthing. “We point out the opportunity to lower costs by strengthening the FDA’s ability to approve drugs in the biosimilar pipeline, which will foster competition that can drive down those prices. Meanwhile, the CMMI can be an important component for creating innovative, appropriately scaled projects that help our patients maintain access to treatments and care.”
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Susan Bernstein is a freelance medical journalist based in Atlanta.