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CMS Commits to Improved Care Quality, Medical Spending Cuts

CMS representatives have focused on listening to providers when creating MACRA regulations and programs for reducing medical spending.

By Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) will continue to work toward creating a better healthcare system for patients while keeping close track of medical spending regardless of which political party is in charge, said Andy Slavitt, CMS Acting Administrator, at the  MACRA MIPS/APM Summit last Thursday.

Value-Based Care Reimbursement

Slavitt went on to discuss the recent history of CMS and the steps the organization has taken to improve healthcare cost and quality over the last eight years. At this point in time, 30 percent of Medicare claims are paid through value-based care models while millions of additional beneficiaries are served through Medicare Advantage plans.

CMS has also seen a significant drop of 565,000 fewer Medicare beneficiaries being readmitted to the hospital less than 30 days after discharge, said Slavitt. Additionally, since the Medicare donut hole for prescription drug coverage was ended, 11 million Medicare beneficiaries saved more than $2,000.

Since the ACA provisions have given 20 million more people health insurance, the number of Americans who have a primary care physician has grown 3.5 percent and the number of families struggling to pay medical bills has fallen from 21 percent in 2011 to 16 percent this year.

“This progress should only be the start if we are to fulfill the real promise of caring for people in our country and doing it in a way that reduces the overall burden of the health care system,” Slavitt said at the summit. “Today, taxpayers spend over $500 billion each year for the Medicare program.”

“The question that needs to be addressed head on is how Medicare will continue to control costs in the face of a demographic boom as over 10,000 Americans enter Medicare each day, rising demand for health care’s new cures and technologies; and an epidemic of chronic disease.”

When moving forward with value-based care to reduce medical spending, CMS representatives attempted to listen to providers to learn how MACRA legislation could be written to improve healthcare delivery, explained Slavitt.

First, a key part of MACRA legislation was focused on fewer regulations and a chance for providers to spend more time on patient care instead of quality reporting. Additionally, MACRA regulations may be the first time for some clinicians to report on quality in an effort to cut medical spending. As such, CMS created a personalized system where healthcare professionals could choose the pace they felt most comfortable with to transition to value-based care.

Slavitt also explained that CMS recognized the providers who are more advanced and capable of moving faster and further into value-based care payment models. CMS created more opportunities in MACRA legislation to allow clinicians to move quickly ahead with alternative payment models.

While CMS has gone forward quickly with implementing alternative payment models and transitioning to value-based care, private payers may not be moving along at the same level. Dr. Farzad Mostashari, Founder of Aledade Inc., previously told that commercial payers are behind and will need to catch up in order to succeed in switching from fee-for-service to value-based care payment models.

“I see some positive trends just in the past two years, but private payers, by and large, are still behind CMS in terms of making it easy for organizations to apply for and qualify for these models,” Mostashari said.

“Medicare has an application process that is complicated but predictable whereas with many private payers, the process itself is opaque and the outcome uncertain. I would strongly suggest that private payers institute more predictable processes and requirements as well as boilerplate contracts that are based off of CMS templates and a clear process for how organizations can apply for and get those risk, value-based contracts.”


Dig Deeper:

Key Steps for Payer Success in Accountable Care Organizations

The Progress and Challenges of the Affordable Care Act


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