HHS teases mandatory bundled models in about-face
HHS Secretary Alex Azar teased potential new mandatory payment models for radiation oncology and cardiac care Thursday in a speech at the annual Patient-Centered Primary Care Collaborative conference in Washington, D.C.
The announcement is an abrupt about-face for the Trump administration, which previously promised it would not force providers into a payment model that would put them at risk of losing money.
The secretary's remarks, sure to frustrate the oncology industry with worries of potential profit loss, came about a week after the administration unveiled its first mandatory payment model seeking to lower American drug costs by tying them an international pricing index.
HHS is now reexamining more voluntary and mandatory models, Azar said Thursday, including those for cardiac care and in areas such as radiation oncology, using all available avenues "including mandatory and voluntary episode-based payment models." He offered no further details.
This is not likely news oncologists want to hear. Though a majority of the industry agreed evaluation and management billing codes needed an overhaul, when CMS released a proposal in mid-October few were happy — with oncologists particularly upset to learn office visit payments could drop roughly 15% if the new rule goes into effect.
The E/M overhaul came as part of the 2019 Physician Fee Schedule and would consolidate billing codes for office visits in an effort to cut down on documentation and reporting requirements.
Both the American Society of Clinical Oncology and the Oncology Nursing Society opposed the E/M changes, asking CMS to withdraw the proposal. It "does not appear to fully offset the direct and indirect cuts to oncology reimbursement, is ambiguous and lacks assurances of long-term durability," ASCO's comment reads.
Oncologists could soon take another regulatory hit if Azar's remarks bear fruit, and are likely to argue that any shifts in payment would negatively impact patient care.
But two JAMA studies released in September showed bundled payments had positive repercussions for patient care and ameliorated high costs — and that hospitals didn't eschew sicker patients for healthier ones, providing some reassurance about such unintended consequences from any new mandatory CMS bundled payment models.
And cost cutting is seriously needed in the arena. Medicare Part B payments for radiation treatment increased by more than 200% between 2000 and 2010, HHS reported to Congress earlier this year. That percentage is only likely to increase as more Americans age into Medicare, driving demand (and cost) of such therapy up.
The Trump administration opening its arms to forcing downside risk is a bit of a volte-face. Just last year it reduced the size of the Comprehensive Care for Joint Replacement Model and stopped the launch of other bundled payment models before they could begin.
The two cardiac models in the works will likely build off the latter two, which CMS canceled late last year. The Cardiac Rehabilitation Incentive Payment Model and the Episode Payment Model were both scheduled to begin Jan. 1 before finding themselves on the chopping block in November.
And the Comprehensive Care for Joint Replacement Model cut spending by almost 4% for participating hospitals, CMS said in August, without impacting quality of care on any significant metrics.
The administration's attitude adjustment comes amid physician wariness of taking on downside risk, but there are strategies providers can take to capitalize on any mandatory CMS payment models on the horizon, including data and tech investment, engaging with the community and promoting value-based infrastructure at the start.
If mandatory models are needed to deliver change, Azar said, "mandatory models are going to see a comeback. Industry groups, however, won't get a chance to officially air their discomfort about that comeback until a rule is actually proposed.
- Healthcare Dive CMS bid to overhaul E/M codes leaves few happy
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