Obama administration races to make Medicare changes as healthcare industry objects

Obama administration races to make Medicare changes as healthcare industry objects
Obama administration races to make Medicare changes as healthcare industry objects

As the clock clicks down on President Barack Obama's days in office, the administration remains focused on adjusting Medicare reimbursements, much to the annoyance of healthcare providers.

Several groups have pushed back against changing Medicare Part B to paying a flat fee for medications, and others have expressed concern about Center for Medicare and Medicaid Innovation demonstration projects.

The American Health Care Association/National Center for Assisted Living is "not opposed to modernizing Medicare with a particular emphasis on improving quality," according to Mike Cheek, senior vice president for reimbursement.

However, it "is concerned about the number of demonstrations CMMI is putting up, many with little evidence on outcomes for beneficiaries." This includes information on Comprehensive Joint Replacement (CJR) and Bundled Payment Care Improvement (BPCI) demonstrations. 

"CMMI has not released any data or preliminary information on CJR experiences because the demonstration has not been operating long enough to collect such information," Cheek said. "We question the rationale for launching three new episodes when little is understood about the first."

Cheek said AHCA "urges the agency to consider the pace of change and unknowns about existing programs before introducing more variables."

The American Hospital Association also has objected to the speed related to increasing bundled payments for hip and knee replacements. In a statement, AHA said while it supports bundled payment models, CMS should in turn “support hospitals by recognizing the significant investments of time, effort and finances that it requires to be successful under these models.”

“We are concerned that, by implementing so many of these programs so quickly, and with so little, if any, evaluation of ongoing models, the agency is putting the programs' success at risk,” the statement said.

In colorful terms, a former Obama administration health official and well-known healthcare policy expert said it was not surprising providers were fighting with the administration over payments.

“No s---, Sherlock,” said Zeke Emanuel, M.D., professor at the University of Pennsylvania, according to The Hill. “Who are you taking the money from? You're taking the money from many of these organizations. They're going to be resistant. It's like, duh.”

Centers for Medicare & Medicaid Services official Patrick Conway, M.D., also told The Hill he is working with Congress on the drug-pricing plan.

“I think we have engaged with members of Congress on the Part B model,” he said.