The Obama administration finalized new experiments for doctors on Tuesday that the incoming head of the Department of Health and Human Services opposed.
The Centers for Medicare and Medicaid Services released a series of regulations as part of a larger effort to tie doctor and hospital Medicare reimbursements to quality. However, President-elect Trump’s pick to lead HHS, Rep. Tom Price, R-Ga., has opposed making participation in some of the experiments mandatory.
The regulations are intended to shift Medicare payments to be based on the quality of care provided. The agency finalized new payment experiments aimed at clinicians who treat patients for heart attacks, heart surgery to bypass coronary arteries, or cardiac rehab and hip fractures.
Under a new experiment, a hospital where a Medicare patient is admitted for care for one of the heart problems or a hip or femur procedure will be accountable for the quality of care provided during the hospital stay and 90 days afterward, CMS said.
So if a patient needs to be readmitted to a hospital due to poor care after being discharged, the hospital could receive a lower Medicare payment.
Hospitals in 98 metropolitan areas will participate in the cardiac care experiment, and hospitals in 67 metro areas will participate in the hip fracture treatment experiments. Both are expected to last for five years.
CMS also finalized new policies to encourage rural doctors to participate in accountable care organizations.
The organizations consist of doctors and hospitals that work together to better coordinate care and get a share of any savings made from such improvements. The new model enables smaller, rural hospitals to participate by lowering the risk to them, CMS said.
Obama administration officials lauded the new experiments.
“These models give providers and hospitals the tools they need to provide the kind of high-quality, patient-centered care we all want for our own families, while also driving down costs for the nation,” said current HHS Secretary Sylvia Burwell.
However, it is not clear if Burwell’s likely successor will feel the same way.
In September, Price led a letter from several Republican lawmakers criticizing the Center for Medicare and Medicaid Innovation, which Obamacare created to oversee new payment experiments, for making doctor participation in the payment experiments mandatory and bypassing Congress’ authority.
The letter refers to the cardiac care experiments that “forces one-quarter of all metropolitan areas across the nation into bundled payments for certain severe cardiac conditions.”
“These mandatory models overhaul major payment systems, commandeer clinical decision-making and dramatically alter the delivery of care,” the letter said.
CMS officials said on a call with reporters Tuesday that they looked at comments on the payment experiments closely.
In addition, the experiments are tied to the Medicare and Children’s Health Insurance Program Reauthorization Act of 2015, which had bipartisan support, according to Patrick Conway, acting CMS deputy administrator.
“We look forward to continue working with all stakeholders on delivery system reform,” he said.
