Lawmakers to CMS: Stop making new payment models mandatory

The letter was sent to CMS Deputy Administrator Patrick Conway, M.D. and Acting Administrator Andy Slavitt
The letter was sent to CMS Deputy Administrator Patrick Conway, M.D. and Acting Administrator Andy Slavitt

The Centers for Medicare & Medicaid Services' mandatory payment models exceed the agency's authority and pose potential risks to older beneficiaries, House lawmakers say in a letter to federal health officials.

Initiatives rolled out by the agency's Center for Medicare & Medicaid Innovation were implemented “on a voluntary, limited-scale basis,” up until the finalization of the Comprehensive Care for Joint Replacement last November, the letter to CMS Acting Administrator Andy Slavitt and Deputy Administrator Patrick Conway, M.D. reads.

The lawmakers claim the CJR, along with the recently announced Cardiac Bundled Payment Model and Part B Drug Payment Model,  “dramatically” overhauls existing payment and care delivery systems and takes control of clinical decision making without the results to back them up.

“[The] statute authorized the Secretary to ‘test innovative payment and service delivery models,' — not mandate them for all providers,” the letter reads. “CMMI's mandatory models ‘experiment' with thousands of patient lives without prior testing on a smaller scale or even a basic indication that they will actually achieve improved quality or, at the very least, maintain present quality.”

The letter, which was sent last week, also raises concerns about mandatory payment models' impact on stakeholders, lack of safeguards, and the “disconcerting” effect the models may have on older adults.

“Policies that have the potential to create access issues for beneficiaries, further provider consolidation, and reduce provider participation in Medicare can drastically deteriorate quality of care our seniors rely on,” the lawmakers said. “This would be a step backwards in our unified effort to move to higher quality, more valued-based care for our nation's seniors.”

The letter's 179 signers — all Republican with the exception of Rep. Brad Ashford (D-NE) — urged CMS to stop all current and planned mandatory payment models, and ensure that future models are limited in size and scope.