Practice Management & Allied Staff News & Materials
Health Reform Law Calls for Testing of Alternative Payment Models
June 16th, 2010
The new CMS Center for Medicare and Medicaid Innovation (CMI), whose establishment by January 1, 2011 is required under the Health Reform law, will test innovative payment and service delivery models to improve quality of care while reducing health spending. Concepts such as the medical home, accountable care organizations (ACOs), payment bundling across episodes of care, a value-based payment modifier under the physician fee schedule and greater overall emphasis on pay for performance are among the alternative reimbursement models being floated.
According to the Congressional Research Service (CRS) Report, Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA), the CMI would work in conjunction with the Patient-Centered Outcomes Research Institute (PCORI), also created under the Patient Protection and Affordable Care Act (PPACA), "to generate new information about how alternative treatments affect patient outcomes as well as evidence to support how different payment methods might alter the incentives for providers and the outcomes for patients."
Also according to the CRS report, "successful models could be expanded nationally. The CBO (Congressional Budget Office) estimates that this provision will lead to an additional savings of $1.3 billion over 10 years." The report concludes that "in the long run, these provisions combined have the potential to be the most substantial of the PPACA and the Reconciliation Act modifications affecting physicians and related providers." AAOMS will continue to monitor these issues to keep the membership informed.