Skip to main content

CMS Reaffirms Commitment to Value Purchasing

Medicaid Payment Perspectives helps Medicaid programs and other payers improve the methods used to purchase care and services for their beneficiaries. It’s published by the Payment Method Development team at Conduent.

The move to value-based payments remains a high priority for CMS and will not be affected by the current healthcare debate in Congress, CMS Chief Medical Officer Dr. Kate Goodrich told the National Quality Forum. The shift from fee-for-service payments (which incentivize volume) to value-based payments (which incentivize quality care) “isn’t a partisan issue,” Goodrich said.

The previous goal of having half of Medicare’s payments through alternative payment models (APMs) by the end of 2018 is unchanged. Goodrich told the NQF annual conference that HHS Secretary Dr. Tom Price and CMS Administrator Seema Verma agree with the need to move from paying for volume to paying for value. It’s important to note that the drive to value purchasing is separate from the ongoing debate about the future of the Affordable Care Act.

“It’s important for hospitals in particular to have predictability about where the system is going and to have a commitment to implementing these changes more rapidly,” Dan Mendelson, president of Avalere Health, told HFMA.

The rule for the second year of the Quality Payment Program (QPP) under the Medicare and CHIP Reauthorization Act (MACRA) is currently being drafted. The quality reporting will change payment for Medicare physicians, with more being brought into the program each year. For most practices, this means mandated quality reporting to avoid cuts in Medicare payment.

Already, CMS is seeing the results of orienting payment with value. Goodrich cited a 21 percent reduction in hospital-acquired conditions (HACs) from 2010 to 2015. “What we’ve seen over a five-year period is a really significant reduction in harm,” Goodrich told the NQF conference, as reported by HFMA.

You can read more Conduent insights about Medicaid payment in previous editions of Medicaid Payment Perspectives.