November 15, 2018

CMS Revisits Mandatory Payment Models to Drive Value-Based Transformation

Health and Human Services (HHS) Secretary Alex M. Azar II identified value-based transformation, including new physician payment models, as one of his administration’s top priorities in a November 8 keynote address to the Patient-Centered Primary Care Collaborative in Washington, DC.

In his remarks, Azar addressed the concept of paying for outcomes. He said new payment models introduced by The Center for Medicare & Medicaid Innovation (CMMI) before the end of this year may require voluntary and mandatory participation to drive value-based transformation. The center intends to revisit some episodic cardiac models that were previously pulled back and to explore new and improved episode-based models in other areas, including radiation oncology.

“Adam Boehler, director of the Center for Medicare and Medicaid Innovation (CMMI), will oversee these efforts,” Azar said. “Boehler has laid out four avenues, known as ‘the four Ps,’ for driving toward value: 1) making patients into empowered consumers, 2) making providers into accountable navigators of the health system, 3) paying for outcomes, and 4) preventing disease before it occurs or progresses.”

The American College of Radiology (ACR) eagerly awaits CMMI’s announcement on launch of new payment models. After Azar’s speech, Seth A. Rosenthal, MD, FACR, chair of the ACR Radiation Oncology Commission, commented with other stakeholders about the pros and cons of bundled treatment approaches included in Azar’s vision of a value-based transformation.

“A lot of details and logistics would need to be worked out to ensure that they would be fair to all stakeholders in diverse practice settings as we proceed towards equitable value-based treatment methodologies,” he said. “We look forward to carefully evaluating the details when this plan is released.”

The American Society for Radiation Oncology (ASTRO) described its views about a mandatory payment model in a statement on its website . The statement describes the society’s enthusiasm for the prospects of a proposed radiation oncology-alternative payment model (RO-APM), but it expresses concern about the possibility of launching a model that requires mandatory participation from all radiation oncology practices at the outset. ASTRO has worked for many years to craft a viable payment model that would stabilize payments, drive adherence to nationally recognized clinical guidelines and improve patient care.

In the statement, the society noted: “ASTRO recognizes that mandatory and voluntary models can take many different forms, and we look forward to working with Secretary Azar and CMMI to determine the best approach for the field of radiation oncology.”