A new federal agency that drew conservative ire for forcing doctors to participate in mandatory Medicare experiments will be on the chopping block with the rest of Obamacare once Donald Trump assumes the presidency.
Republicans have said repealing Obamacare is a top priority for the new Congress that takes power alongside President-elect Trump in January. A repeal effort championed by Republicans last year would dismantle the law, and in particular, the Center for Medicare and Medicaid Innovation.
A top Republican who is pushing that same repeal bill that uses the Senate procedural move reconciliation has serious reservations about the center.
Sen. Mike Enzi, R-Wyo., is no fan, as he has "serious concerns about the construct of the center," said spokesman Max D'Onofrio. Enzi is pushing a version of the repeal bill that includes language to gut the center.
The center was originally created under Obamacare and was given $10 billion in funding from 2010 to 2020. It was created to test new payment models for the entitlement programs Medicare and Medicaid.
A major goal of Obamacare was to shift Medicare payments away from a traditional fee-for-service model, where a doctor or hospital gets paid for every test or service, to a quality of care model that takes into account the care people get. However, the center has been a lightning rod for controversy, especially from Republicans.
Republican lawmakers charge that the center has exceeded its authority and ignored Congress in several proposals. Republicans also railed against mandatory experiments that required participation from doctors.
Chief among the complaints is a mandatory experiment to cut payments to doctors under Medicare Part B for drugs administered in doctors' offices such as chemotherapy. The idea behind the project was to get doctors to prescribe drugs that have better value, rather than just prescribing more expensive drugs in order to get a higher reimbursement.
Republicans blasted the proposal, saying that it will force doctors into an experiment against their wishes that could impact patient care.
"We insist CMMI stop experimenting with Americans' health and cease all current and future planned mandatory initiatives," according to a letter from more than 100 lawmakers to top administration officials in September.
Supporters of the center argue, however, that if the GOP gets its way, another federal entity will have to be created to test new payment models. For example, Republicans are broadly in favor of payment reforms under the Medicare Access and Children's Health Insurance Program Reauthorization Act passed last year, which calls for the testing of alternative payment models for Medicare.
Bob Berenson, a fellow at the left-leaning think tank Urban Institute, said the Obamacare center can help coordinate these experiments.
"You need some large body of people to be administering these demonstrations," he said. "You need to pay a lot of people and pay contractors to do the evaluations."
Some examples of these demonstrations include a voluntary experiment where doctors can get a 5 percent boost to Medicare payments if they participate in comprehensive primary care plus.
The model would phase in a quality-of-care payment model for doctors, tying Medicare payments to certain quality measures including adopting electronic health records and 24/7 patient access.