Advocating for CMMI Reform, Looking Ahead to Alternative Payment Models

The work of health policy reform is a marathon, not a sprint. The ACR is encouraged by the forward progress being made in collaboration with the American Medical Association and other physician-led organizations within the Healthcare Leaders for Accountable Innovation in Medicare and Medicaid coalition (known as the AIM coalition) to advocate for physicians’ ability to provide care for their patients.

ACR & AIM
The ACR joined the AIM coalition as part of its efforts to drive the cancellation of the Medicare Part B demonstration project, which would have affected prescribing practices and potentially forced rheumatologists to send their patients to the hospital for infusion treatments.

The Center for Medicare and Medicaid Innovation (CMMI) was responsible for developing the now-defunct Medicare Part B demonstration project, which was less like a true demonstration project and more like a law that would have been applied at the national level. The CMMI was created to develop new innovation models for payment and other related reforms, and this is important work, explains Adam Cooper, MS, ACR senior director of government affairs.

As AIM coalition members look ahead to the reality of reformed payment models and other changes in healthcare, Mr. Cooper says the ACR and the AIM coalition deem it important to support a reformed CMMI in furthering the development of new payment models and other reforms. “It’s important that we support the agency in its intended, basic role and to offer constructive ideas for supporting that mission, while ensuring proposals like the Part B demo never happen again.”

6 Reform Principles
With the AIM coalition, the College has been advocating for CMMI reforms that can support this vision for the future, and significant progress has been made so far. This progress includes a meeting in April with Health and Human Services (HHS) Secretary Tom Price, MD, to discuss a letter sent in February to the HHS outlining six recommended principles the coalition believes can be implemented to reform the CMMI. The principles call for the CMMI to:

1. Foster strong scientifically valid testing prior to expansion;
2. Respect Congress’s role in making health policy changes;
3. Consistently provide transparency and meaningful stakeholder engagement;
4. Improve sharing of data from CMMI testing;
5. Strengthen beneficiary safeguards; and
6. Collaborate with the private sector.

As noted in this letter, the ACR and other coalition members agree that as the U.S. healthcare system continues to transition from fee-for-service to value-based care, appropriate testing of new ideas can make healthcare more quality driven, cost effective and patient centered.