The CMS will only use mandatory payment models when the agency feels it can't get enough participation or have adverse selection for voluntary models, a Center for Medicare and Medicaid Innovation official said on Friday.
The remarks from deputy director Amy Bossano during the National Association of ACOs spring conference in Baltimore comes a day after CMS Administrator Seema Verma hinted that some upcoming models will be mandatory.
However, Verma did not say which payment models nor how many would be mandatory.
Bossano said during a CMS town hall that the agency doesn't have a "formula per se" to determine if a model would be mandatory.
"We will use it very judiciously," she said regarding making models mandatory.
A key factor will be whether the Innovation Center would have low participation in the model if it was voluntary, Bossano said.
She also added that adverse selection was a concern, which Verma also referenced in her remarks.
"Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate," Verma said. "Requiring participation also helps us understand the impact of our models on a variety of provider types."
Bossano said that the Innovation Center will lay out in rulemaking how future mandatory payment models will work with voluntary ones, noting it will be a case-by-case basis.
"We would lay out in our rulemaking to be clear how it is going to work," she added.
On Monday, HHS launched two new voluntary payment models targeted at primary care physicians. One of the models targets small primary care practices and the other focuses on larger practices and health systems.
The Primary Care First (PCF) model would give clinicians a monthly payment to cover all Medicare costs and give higher payments to doctors that specialize in care for high-need patients, including those chronic conditions.
The agency also launched a payment model called Direct Contracting for larger healthcare systems, including ACOs. The model offers two options: one where providers assume 50% of the risk and another where they take on full risk.
Some ACOs said at first glance the models could be a double-edged sword for hospital ACOs trying to attract physicians, but they're waiting for more information.
"This is an opportunity for physicians now in primary care plus that haven't been engaged with our ACOs can now join the ACOs because they will need experience to move into a primary care model," said Tom Kloos, the president of the Atlantic ACO in New Jersey, during a panel discussion Thursday. "There is also an opportunity for my best performing practices to say 'Hey I am tired of being held back by others in my ACO. I can go off to do this on my own.'"
