CMMI Reform Bill Would Actually Undermine Value-Based Care Progress, AAFP Says

Feb. 11, 2020
Primary care group says bill would impose a level of bureaucracy that would stifle care transformation

The American Academy of Family Physicians  issued a statement opposing a recently introduced piece of legislation designed to increase transparency and accountability within the Center for Medicare and Medicaid Innovation (CMMI). AAFP says instead the bill “would undermine meaningful progress in the shift toward value-based care.”

HR 5741, the Strengthening Innovation in Medicare and Medicaid Act, was introduced Feb. 3 by U.S. Reps. Terri Sewell (D-AL), Adrian Smith (R-NE), Tony Cárdenas (D-CA) and John Shimkus (R-IL). This bill is in the first stage of the legislative process.

Some of its provisions include allowing providers to apply for hardship waivers; requiring continuous monitoring on a real-time basis the effect of a model; and the provision of advance public notice and an opportunity for stakeholder input and public comments to ensure transparency and accountability regarding the establishment, testing, implementation, evaluation, and expansion of a model. It would also require CMMI to consider geographic overlap in value-based care programs.

 “The Innovation Center has been a critical component of Congress’ mission to deliver value-based health care focused on positive outcomes, especially in rural and underserved communities where health care providers struggle to take on the financial risks required to innovate patient care. It is essential that Congress ensures that CMMI functions as intended, to improve the quality and efficiency of care delivered, and incorporates greater opportunity for public input,” Rep. Sewell said, in a statement. “The legislation we introduced today would safeguard the Center from implementing politically driven or other policy changes made unilaterally by any administration that could be harmful to patients and providers.”

The statement from AAFP President Gary LeRoy, M.D., called the legislation a major step backward. “CMMI has not only transformed Medicare payments, but it has been a catalyst for private sector and state-led initiatives as well. While well intentioned, HR 5741 would have a chilling effect on that progress,” LeRoy said. “HR 5741 would fundamentally alter CMMI’s authority by imposing a level of bureaucracy that would stifle care transformation through requiring congressional approval at all phases of a model, arbitrary model parameters and expansion requirements, and burdensome reporting requirements.” 

He added that the AAFP fully supports transparency and responsible stewardship of Medicare resources but the organization believes that HR 5741 would actually waste resources by forcing the already limited CMMI staff to devote energy to bureaucratic processes rather than focusing on developing and testing models. This additional paperwork burden could slow, if not halt, the release of new models, he said.

“Family physicians are on the frontlines delivering care in our communities and have partnered in good faith to shift to a system that fosters innovation and provides better outcomes,” LeRoy said. “Nearly 70 percent of all primary care practices participating in CMMI’s Comprehensive Primary Care Plus initiative included family physicians. This model has led to significant improvements in care delivery which would not have been possible without the resources and convening power of CMMI.”

Even more family physicians are eager to participate in alternative payment models that reward value over volume, and the AAFP would like to see more new models being tested by CMMI, not fewer, he added. “Congress passed the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) to incentivize clinicians to participate in advanced alternative payment models, and CMMI is the primary source of those opportunities. HR 5741 would limit the scope of future CMMI models and prevent the timely release of new models, which in turn limits the number of physicians able to participate.”