During a Senate Finance Committee hearing, Sen. Ron Wyden (D-Ore.) said he sees the Center for Medicare and Medicaid Innovation's Primary Care First policy as an opportunity for more chronically ill patients to be cared for in their home.
Wyden has worked for years on home-based care for the seriously ill, and led the effort on the Independence at Home demonstration. He told the panel he'd like to "get the old band together again" of bipartisan senators who worked with him on that demo to see how Primary Care First could expand on the same goals.
He asked the witnesses to send the committee feedback on how they could see the model functioning for home-based care.
The witnesses, who mainly represented major physician groups, by and large said they supported the Innovation Center model, although they offered some caveats.
When it came to home-based care, Dr. John Cullen, president of the American Academy of Family Physicians, said that he's seen a lot of interest from other physicians in that part of the Innovation Center program, particularly because of the additional money the CMS is bringing to the table for treating the chronically ill.
But as Sen. Bill Cassidy (R-La.) pressed witnesses for their thoughts on the model, Dr. Scott Hines of the AMGA said he was skeptical that capped payments can work when patients can technically opt for any doctor they want—a key promise from the Trump administration officials.
Capitated payments would call for at least some network limits, Hines argued, so patients can be steered toward physicians "who are high quality and low cost."
American Medical Association President Dr. Barbara McAneny said the government will have to be careful as it scales how much risk small practices in particular are expected to take on. She liked the Trump administration's idea of starting out with prospective payments to give a financial buffer for physician practices, describing the effort as a "great opportunity to do a test for this and see" how it could work.
Throughout the hearing, senators were also eager to talk about how alternative payment models are working in rural areas.
Hines urged lawmakers to make permanent the 5% alternative payment model bonus to rural physicians as a way to get more of them to participate. All the various rules for accountable care organizations should be synced, he added, "so when folks learn how to take on risk, the same rules apply."