in Health Affairs blog
By John Rother and Larry McNeely
The pace of change in the United States’ health care system is accelerating. Building on work by private and public payers, Centers for Medicare and Medicaid Services (CMS) officials are pursuing a transformation of how our health care system pays for care, spurred on by the passage of last year’s bipartisan sustainable growth rate (SGR) reform legislation and Health and Human Services (HHS) Secretary Sylvia Mathews Burwell’s own payment reform goals. The destination is a wholesale transition away from the incentives for volume over value inherent in fee-for-service medicine.
But even as recent press coverage and HHS announcements suggest that reform is picking up speed, providers and plans are facing significant speed bumps. It’s time that Congress give providers and plans the tools needed to deliver on the promise of better care at lower cost.
To be sure, HHS’ efforts are promising. On July 7, regulators offered up a draft Medicare physician payment rule which bolstered reimbursement for care coordination and planning and covered diabetes prevention programs. The Center for Medicare and Medicaid Innovation (CMMI) has announced sweeping tests of bundling and medical home models. Secretary Mathews Burwell has already deployed the Affordable Care Act’s expansion authority to implement elements of the Pioneer Accountable Care Organization (ACO) Demonstration and the Diabetes Prevention Program. And this November 1, after sorting through 3,874 public comments, CMS will issue its final rule implementing payment incentives for physicians and clinicians to participate in alternative payment models.
Yet the truth is that the underlying Medicare law was built for a purely fee-for-service system. And as alternative payment models evolve and grow, they are encountering significant statutory barriers to their success — barriers that only Congress can bring down.
Read the full Health Affairs Blog here.