The adoption rate of value-based payment models in Medicare has been slow and providers hold the CMS partly accountable.
For providers to be successful, financially risky models need to be predictable. That often isn’t the case for models coming out of the Center for Medicare and Medicaid Innovation, a group of stakeholders led by the National Association of ACOs wrote in a letter last week to CMS Administrator Seema Verma and CMMI Director Adam Boehler.
The CMMI doesn’t currently ask for public stakeholder input before launching new models. It’s also not uncommon for changes to be made to models in the middle of performance periods.
“Our concerns are heightened by the fact that we are moving to more at-risk models and when the providers are signing a contract that puts their balance sheet at risk. … If you have not been part of the process you are reluctant to do that,” said Clif Gaus, CEO of the association.
A CMS spokesperson said the agency received the letter and appreciates the input from stakeholders. The spokesperson added that CMMI "regularly" asks for feedback on payment models through requests for information, listening sessions and meetings. But at the annual HIMSS conference in February, Boehler acknowledged that the agency needs to work on improving the stability of the models.
“As we look at new models where you are giving more full accountability, I do think it is incumbent upon us to do our best to give predictability to models and to simplify as much as possible,” he said during a media briefing. “It’s something we’ve heard from the participants quite a bit. I understand that need, and we are working hard on that need.”
Despite all the buzz about the transition to value-based payment in recent years, actual adoption isn’t widespread. In a recent survey of more than 500 C-suite executives from consultancy Numerof & Associates, 66% responded that less than 20% of the total revenue at their organizations was tied to risk-based agreements. Just 6% had more than 80% of their total revenue tied to risky contracts.
Not surprisingly, the executives surveyed listed fear of financial losses as the biggest reason why they have been hesitant to take on the models.