Making new Medicare payment models mandatory is crucial to avoid “selection effects,” where only providers who benefit financially from a model participate, reducing potential savings, said Medicare chief Seema Verma.

She recently added the move toward value must speed up, and she wants more provideders in such models soon.

Providers, however, are worried about potentially “devastating” consequences for struggling nursing homes and want a slower pace. 

“Value-based care means upending the current paradigm, and in my view it’s not happening fast enough,” Verma said in a speech to the National Association of Accountable Care Organizations in April. New payment models under development would focus on patients with high medical needs, including those suffering from cancer, living in rural areas, or with end-stage renal disease.

“Requiring participation also helps us understand the impact of our models on a variety of provider types,” Verma added. 

Skilled care advocates have expressed reservations about models — such as bundled payment and ACOs — that often cut costs on the backs of nursing homes. Not all SNFs have cash on hand to make the necessary investments in transforming the delivery system, LeadingAge noted to McKnight’s. Nor do providers always have sufficient volume of Medicare cases to spread the risk of high-cost patients. 

“Such an approach — where it involved smaller, rural nursing homes, small home health agencies, or other similar providers — could be financially devastating,” Nicole Fallon, LeadingAge’s VP of health policy and integrated services, told McKnight’s. “Mandatory models are not appropriate for all providers.”