Providers and insurers are among healthcare leaders lobbying Congress and the Trump administration to continue to push Medicare into value-based payment models.
A number of healthcare organizations, including the Healthcare Leadership Council, a coalition of CEOs from various sectors of the industry, sent letters to Republican lawmakers hailing the benefits of payment models that focus on quality and value.
“We're looking for a signal from incoming policymakers that they continue to support (these models) and the investments being made in the private sector,” said Jeff Micklos, executive director of the Health Care Transformation Task Force, a consortium of providers, payers, purchasers and others that have committed to putting 75% of their business in alternative pay models by 2020.
Adopting value-based payment models such as accountable care organizations can cost anywhere from millions for many moderately sized physicians' practices to billions for major healthcare systems, according to estimates by the American Medical Group Association. The models require technology to track quality metrics and encourage collaboration between providers that could also result in added costs. Those investments could be lost if the models end.
President Donald Trump hasn't spoken in support or opposition of moving away from fee-for-service. His nominee for HHS secretary, however, does appear to want to continue the trend. U.S. Rep. Tom Price, a surgeon from Georgia, supports, for example, bundled payments for some procedures.
Price has, however, been very critical of the Center for Medicare & Medicaid Innovation, which created many of the payment models.
The Innovation Center was instrumental in the Obama administration's goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models. The goal was to hit 50% by the end of 2018.
During Tuesday's Senate confirmation hearing, Price said the Innovation Center had “gotten off track.” He and other Republicans said the mandatory nature of some of the pilot programs was “dictating to physicians how they must practice." He said the center, which was created under the Affordable Care Act, should change focus in a way that benefited patients.
The healthcare coalition that wrote Congress included in the letter a request to require federal and commercial payers to share claims data with healthcare providers. Many fear the claims information will curb competition, preventing some organizations from negotiating with hospitals. Access to this data is often denied or limited, the trade group said.
Industry stakeholders also want increased use of safe-harbor waivers and exemptions to protect hospitals from inadvertently violating anti-kickback laws when providers collaborate on value-based pay initiatives.
The relationships, in which one provider pays another, can be viewed as illegal.
The fear of penalties, felony conviction, or exclusion from Medicaid and Medicare has dampened interest in alternative pay models. Congress would have to intervene to add more flexibility to anti-kickback laws.
Several congressional committee hearings have been held to discuss possible changes to the laws because of this complexity.
"A key message we're sending is continue to incentivize providers to enter into these kind of systems," Michael Freeman, executive vice president of Healthcare Leadership Council said.