House lawmakers create bipartisan caucus on provider pay models

On the Hill

House lawmakers recently announced the creation of the Healthcare Innovation Caucus to address provider pay models. As the Centers for Medicare and Medicaid Services (CMS) determines what direction to take payment and delivery reform, provider pay model policies will determine how the Medicare physician payment system will reimburse doctors moving forward. According to founding member Rep. Mike Kelly (R-PA), the caucus will focus on exploring innovative and successful payment models as the healthcare industry moves to a value- and outcome-based model. There is significant interest in new models from providers, since the Quality Payment Program (QPP) provides bonuses to physicians who receive a certain portion of income from so-called alternative pay models. Providers are frustrated, however, with the slow pace at which CMS is approving new recommended pay models.

Negotiations over legislation to stabilize Affordable Care Act (ACA) markets may have reached an impasse due to abortion-related language in the bill (known as the Hyde amendment). With progress stalled, it remains unclear whether the stabilization bill will be included in the omnibus spending package, which House Republicans hope to release by the evening of March 19. Senator Lamar Alexander released an updated version of the market stabilization bill, which calls for $10 billion in reinsurance funding per year for three years, funding for cost-sharing reduction subsidies, added flexibility for 1332 waivers, increased eligibility for copper plans and Hyde-amendment language prohibiting federal funding of abortions. Neither party wants to budge on abortion restrictions, which Republicans demand but Democrats refuse. According to an analysis by Oliver Wyman, the stabilization measures would lower premiums by up to 40 percent, and the Congressional Budget Office found that the bill could lower premiums by 10 percent next year and 20 percent in both 2020 and 2021. However, the disagreement over Hyde-amendment language leads insurers to doubt whether stabilization provisions will be included in the omnibus bill.

At the agencies

Health and Human Services Secretary Alex Azar laid out a series of priorities for the agency at a Federation of American Hospitals conference. The priorities include improving patient access to their medical records, increasing transparency, using MACRA and CMS innovation centers to move toward pay-for-performance and reducing government burdens. These priorities largely mirrored those of the Obama Administration’s final years, though the methods to achieve them will likely differ.

While announcing the MyHealthEData initiative, CMS Administrator Seema Verma announced plans to focus on interoperability and streamlined reporting as part of an overhaul that will include the meaningful use program. The agency will also address certain documentation requirements to enable providers to more easily access electronic health records. The goal of the MyHealthEData initiative will be to give patients more control over their medical records and to make it easier for providers to coordinate care. CMS is also taking steps to prevent information blocking by requiring participants in some CMS programs to prove they are not engaging in such tactics.