During the last weeks of the Obama Administration, CMS continued to roll out new mandatory bundled payments models. Rep. Tom Price (R-Ga.), Donald Trump’s nominee for HHS Secretary has publicly raised concerns about CMS’ bundled payment programs and the final MACRA regulations published by CMS in 2016. Industry is watching and waiting to see whether the news programs, and perhaps the MACRA regulations themselves, are ever fully implemented. Although Rep. Price has spoken out against some reforms like the Part B Demonstration and MACRA regulations, he has later clarified support for a scaled-back CMMI and other MACRA concepts.
Senate questions
During questioning before the Senate HELP Committee, Price, who has criticized CMMI in the past, said that it “has great possibility and great promise.” Price said he is opposed to CMMI making certain payment models mandatory. Price added, “I am a strong proponent and advocate for innovation, but I have seen in certain instances what is coming out of CMMI is a desire to require certain kind of treatment for certain diseases that may or may not be in the best interest of the patient.”
Furthermore, in a document titled Questions for the Record “The Honorable Thomas E. Price Nomination Hearing for HHS Secretary,” Price offered over 130 pages of answers to questions from the Senate Finance Committee. Price told lawmakers “significant challenges remain” with implementation of the 2015 Medicare physician payment law. Last fall’s final MACRA rule “took steps to address physician concerns,” he added.
“If confirmed, I plan to direct the CMS administrator to ensure that the program is structured to achieve its quality and budgetary goals, while ensuring that patients and the providers who care for them are at the center of our reform efforts,” Price wrote.
Two questions and answers of note
16. Question: You voted for the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) when it was considered on the House floor. Will you commit to working with Washington state health care providers to help them succeed in Medicare’s new Quality Payment Program, as outlined in regulations by CMS, including Advanced Alternative Payment Models?
Answer: If confirmed, I commit to work closely with the CMS Administrator to make sure we implement MACRA in a way that is easy to understand, minimizes burden, and is fair to all affected providers.
27. Question: Do you support the continuation of the new Merit-based Incentive Payment System as presented in the final rule on the Medicare Access and CHIP Reauthorization Act (MACRA)?
Answer: The recent CMS MACRA final rule approached the first year of the Quality Payment Program as a transition year, and took steps to address physician concerns regarding the burdens associated with program participation. I think significant challenges remain with respect to provider burden, and, if confirmed, I plan to direct the CMS Administrator to ensure that the program is structured to achieve its quality and budgetary goals, while ensuring that patients and the providers who care for them are at the center of our reform efforts.
Conclusion
We will continue to monitor this as Rep. Price will almost certainly become the next Secretary of HHS. It appears he favors reforms to MACRA and value-based programs, but not outright repeal or an end to CMS innovation projects. CMMI, the innovation center within CMS, may take on a more conservative approach such as less mandatory projects, but it will be important to see where Price draws the line between required participation and CMS’ stated goal in promoting value-based programs.