CMS innovation unit ‘hobbled,’ data collection possibly aimless

The CMS Innovation Center is being crippled by the Trump administration and might not be collecting the correct data from new payment models, according to a group of researchers.

The focus on voluntary participation in programs by the Center for Medicare & Medicaid Innovation Center (CMMI) is hurting payment reform by possibly providing an inaccurate depiction of how such models will perform nationwide, researchers including Rahul Rajkumar, M.D., chief medical officer at Blue Cross Blue Shield of North Carolina, University of Michigan law professor Nicholas Bagley and Yale professor Scott Levy wrote in the New England Journal of Medicine.

“Voluntary programs don’t always provide insight into whether a payment approach ought to be rolled out on a nationwide basis,” they said.

While payment reform, like value-based care and population health, is popular throughout the healthcare sector, providers have been slow to adopt to changes and have pushed back on aggressive new payment changes. Those providers have found refuge in the Trump administration’s approach, which has watered down or completely ended some mandatory programs.

The researchers specifically called out the administration’s “backpedaling” of mandatory programs, like bundled payments for hip and femur fractures last year. Following the rollback, the agency, as expected, released a voluntary replacement bundle.

Last fall, CMS Administrator Seema Verma called for industry input to guide the innovation center in a “new direction.”

The CMMI was initiated under the Affordable Care Act as a way to test payment models that have the potential to lower cost and improve patient outcomes. The researchers said the center is not living up to expectations.

Congress “would not have delegated to CMMI the extraordinary power to reshape Medicare and Medicaid while prohibiting the agency from amassing the highest-quality evidence about which models are effective,” the authors wrote.

The Department of Health and Human Services (HHS) has given mixed signals over the past year on how it plans to proceed with new CMMI models. Tom Price, President Donald Trump’s original, and short-lived, HHS secretary strongly opposed mandatory models, while current secretary, Alex Azar, voiced more support.

Last month, Azar appointed former Landmark Health CEO Adam Boehler to lead the Innovation Center.

CMS administrator Seema Verma has signaled that a larger quantity of voluntary programs is the best way to control costs by giving providers more choices, but one healthcare expert said that will only make things worse.

“The CMS has urged on the side of having too many programs and models, and its a little bit overwhelming for many organizations to try and keep up with and for the agency to manage,” Michael Abrams, co-founder and managing partner of Numerof & Associates, told FierceHealthcare.

Abrams also agreed with the authors that voluntary models are not always reflective of how the entire industry will react to a new program. He added that fewer payment models provide a better focus on data, which would lead to better research on what programs work.

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