In a speech before the Patient-Centered Primary Care Collaborative Conference, HHS Secretary Alex Azar outlined the agency’s strategy for driving toward value. He noted that CMS will soon roll out mandatory Medicare payment models for cancer and “revisit” voluntary cardiac care models. “Bundled Payments for Care Improvement is a voluntary model, where potential participants can select whether they want to join. But we’re not going to stick to voluntary models,” Azar said.
Azar Remarks and Mandatory Models
Sec. Azar acknowledged that of his main priorities, looking at how to deliver better value from our entire healthcare system may be the most ambitious and requires significant collaboration with the entities that need to transform. The remarks by Sec. Azar reinforce HHS’ commitment to pursuing a range of strategies for moving towards value-based care. Last year, CMS canceled the Episode Payment Models and the Cardiac Rehabilitation Incentive pay model while also paring back the mandatory Comprehensive Care for Joint Replacement demonstration. The impetus behind the 2017 change in direction appears to have come in large part from the views of former HHS Secretary Tom Price, who opposed the mandatory demonstrations.
During his confirmation hearing in January Azar told the Senate Finance Committee that “we need to be able to test hypotheses.”
“I want to be a collaborative in doing this. I want to be transparent and follow appropriate procedures. But if to test a hypothesis around changing our healthcare system it needs to be mandatory as opposed to voluntary to get adequate data, then so be it,” Azar told the committee.
Response
Following comments today from Alex Azar, the Secretary of Health and Human Services, on an alternative payment model for radiation oncology, the American Society for Radiation Oncology (ASTRO) issued the following statement from CEO Laura Thevenot:
“ASTRO greatly appreciates Secretary Azar’s remarks today on a forthcoming radiation oncology alternative payment model (RO-APM), and we’re pleased that a RO-APM is getting closer to reality […] While ASTRO is enthusiastic about the prospects for a RO-APM, we have concerns about the possibility of launching a model that requires mandatory participation from all radiation oncology practices at the outset. 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.”
There is likely going to be pushback against mandatory proposals as radiation treatments are very profitable for providers in the current models. Health systems have also made huge investments in oncology as a growth area. This new proposal, coupled with the earlier announcement targeting Part B drug spending (which will also disproportionately impact oncology providers), is sure to create controversy.