In 2015, then-HHS Secretary Sylvia Burwell announced an ambitious goal for half of all Medicare payments to be tied to value-based care models by the end of 2018—but that’s not a priority for the agency under President Donald Trump, a CMS spokesperson told the Washington Post.
“The Trump administration’s focus has not been on a specific targeted number by the previous administration, but rather on evaluating the impact of new payment models on patients and providers,” said CMS spokesman Raymond Thor.
Under CMS Administrator Seema Verma, MPH, as well as Trump’s first HHS secretary, Tom Price, healthcare agencies have altered or scaled back previous efforts at pushing the value-based care transition while publicly committing to moving away from fee-for-service. One of the biggest changes was when CMS greatly increased the number of clinicians exempt from the Merit-based Incentive Payment System (MIPS) for 2018, raising low-volume thresholds to $90,000 in Medicare Part B charges and treating 200 Medicare beneficiaries—an increase from the 2017 exemption levels of $30,000 and 100 beneficiaries.
The American Medical Group Association (AMGA) criticized these shifts as potentially hindering the prospects of value-based care. Nixing the Burwell goal, however, isn’t that big of a deal, according to AMGA’s vice president of public policy Chet Speed, as its members viewed it more as an aspirational benchmark than true policy.
“Our members expect 61 percent of their federal revenues to come from a value-based payment model. It’s safe to say our members have already exceeded the Obama administration goal,” Speed told HealthExec. “That said, moving from volume to value is incredibly challenging, requiring a re-design of clinical, administrative, and financial systems, as well as a healthy dose of change management skills. Also, moving to value means all parts of the healthcare industry need to play, and as our survey shows, our members haven’t largely seen that from key healthcare players.”
AMGA has argued CMS could be doing more to drive the transition to value, such as streamlining requirements for its payment systems for Medicare FFS, Medicare Advantage and accountable care organizations (ACOs). It’s also showed a greater willingness than other groups to make more dramatic shifts, including following through on recommendations to scrap MIPS altogether if it “isn’t the way to Medicare to value.”
Stakeholders who have been less critical of the Trump administration’s moves on payment models also saw little reason to be worried over leaving the Burwell goal behind.
“It was an exaggerated goal that wasn’t backed up by substance,” Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), told HealthExec. “For all its promises, the prior administration didn’t produce a sufficient number of (alternative payment models) to meet its own goal.”
There have been small signs new HHS Secretary Alex Azar will be a greater proponent of these models than Price and perhaps even Verma. In his congressional hearings as a nominee, he said shifting to value was one of his top priorities at HHS and even spoke in favor of making payment models mandatory if it was necessary to “get adequate data.”
Allison Brennan, vice president of policy at the National Association of Accountable Care Organizations (NAACOS), told HealthExec moving away from the 50 percent of payments tied to value by 2018 goal is more a reflection of a new administration wanting to set its own goals rather than be beholden to their predecessors’ policies.
“This is not a reflection of a lack of commitment to the transition to value-based care and payment models,” Brennan said. “In fact, the current administration has taken a number of active steps to support the transition to value-based care, and this transition has had broad, bipartisan support from leaders in Congress as well as those in the executive branch.”