October 07, 2016

Congressmen Express Opposition to CMMI

More than 170 Republicans and one Democrat have co-signed a letter spearheaded by Reps. Tom Price, MD (R-GA), Charles Boustany, MD (R-LA) and Erik Paulsen (R-MN) in opposition to the Centers for Medicare and Medicaid Innovation (CMMI), a key department within the Centers for Medicare and Medicaid Services (CMS).

Created by the Patient Protection and Affordable Care Act (PPACA), CMMI was granted broad legal authority to test innovative payment and care delivery models. Opponents of PPACA argue that CMS’ health care “think tank” is a waste of scarce federal resources and inappropriately usurps Congress’ constitutional authority in creating, evaluating and potentially expanding key legislative policies.

The opposition letter highlights three recently enacted CMMI demonstration projects, specifically the Comprehensive Care Joint Replacement (CCJR) payment model, the Medicare Part B Prescription Drug payment model and the Cardiac Bundled Payment Model, as microcosms of problems facing this key cog of the federal health care reform act.

The letter criticizes CMMI for deviating from PPACA’s statutory intent by forcing mandatory physician participation in these new payment models and insisting on implementing these policies in numerous geographical areas throughout the U.S. Federal lawmakers also chastise CMMI for its unwillingness to more thoroughly consult impacted stakeholders prior to implementing these demonstration projects. The letter concludes with members of Congress requesting CMMI to cease all current and future mandatory initiatives.

The American College of Radiology (ACR) actually received CMMI grant money to initiate the Radiology Support, Communication and Alignment Network (R-SCAN) program, a collaborative action plan that brings radiologists and referring clinicians together to improve imaging appropriateness based upon a growing list of imaging Choosing Wisely topics. R-SCAN is a free tool that delivers immediate access to web-based tools and clinical decision support technology to help ordering physicians optimize imaging care, reduce unnecessary imaging exams and lower health care costs. Although ACR has received grant money from CMMI for R-SCAN, the College shares some of the concerns expressed by the recent letter from Capitol Hill.

The effort to critique CMMI follows a Sept. 7 House Budget Committee hearing, chaired by Rep. Price, on the scoring techniques the Congressional Budget Office (CBO) applies to various CMMI proposals. CBO officials testified that they use various econometric formulas to determine whether CMMI demonstration projects are expected to save or cost the federal government money, but they were unwilling to provide the committee with a specific equation the CBO uses to measure savings or costs.

In the aggregate, CBO continues to believe that any attempt to repeal CMMI will eliminate anticipated savings of $34 billion dollars over 10 years. House Republicans, however, strongly question this figure considering all previously approved CMMI demonstration projects have yet to yield savings, despite being in operation for many years. In addition, the House Budget Committee is frustrated that any attempt to alter existing CMMI demonstrations via legislation are scored as costing the federal government additional money.

The ACR’s government relations office will continue to monitor issues relating to CMMI. No legislative action is expected on this particular aspect of PPACA until the next Congress convenes.