5 major value-based care moves under the Trump administration so far

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Based on key actions taken over the past year, the Trump administration appears to be pumping the brakes on HHS' value-based care goals. 

A CMS spokesperson confirmed this strategy to The Washington Post, noting the administration is shifting focus away from the goal of tying 50 percent of Medicare payments to value by the end of 2018, and putting that focus into evaluating the efficiency of the pilots underway at the CMS Innovation Center.   

So far, the Trump administration's moves in the value-based care arena support this strategy. Here are five major actions taken by the administration so far.

1. CMS proposed canceling cardiac bundled payments and scaling back the Comprehensive Care for Joint Replacement program on Aug. 14, 2017, and finalized those changes on Nov. 30, 2017. The final rule officially canceled the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model, which were slated to begin in 2018. It also reduced the mandatory requirements associated with the CJR model, letting hospitals off the hook in 33 of the 67 geographic areas selected to participate, as well as any low-volume and rural hospitals.

2. In September 2017, CMS issued a request for information seeking input on a "new direction" for its Innovation Center. The request sought more information on how to increase participation in alternative payment models and other innovation models, as well as program integrity, a chief concern of the Trump administration. Here is how four healthcare groups responded to the request.

3. CMS introduced a voluntary bundled payment model in January called the Bundled Payments for Care Improvement Advanced. The model includes 32 different clinical episodes and qualifies as an advanced Alternative Payment Model under the Quality Payment Program. It is the first advanced APM introduced under the Trump administration, and the first cohort is slated to begin Oct. 1.

4. HHS Secretary Alex Azar told the Senate he was in favor of mandatory pilots during his confirmation hearing in January. This marks a change in sentiment from his predecessor, Tom Price, MD, who opposed mandatory pilots. Mr. Azar backed the programs, noting mandatory participation is sometimes necessary for adequate testing. However, Mr. Azar has not acted on this sentiment yet.

5. Mr. Azar indicated HHS may end or significantly reduce reporting requirements under the Merit-based Incentive Payment System in remarks to the Senate earlier this month. This is in step with President Donald Trump's 2019 budget, which suggested assessing clinician performance with claims data and patient surveys. This system eliminates the need for physicians to actively report data.


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