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Congress people want CMS to do more to encourage risk-based payment models


70 members of the U.S. House of Representatives have asked the Centers for Medicare & Medicaid Services to make   it easier for providers to take part in risk-based payment models by removing regulatory barriers that encourage fee-for-service payment.

The legislators want  CMS to waive certain regulations that offer cash incentives under fee-for-service delivery models, thereby slo reform.

Becker’s Hospital Review says the House group is  asking CMS to reconsider such “regulations as the Long-Term Care Hospital 25 percent rule because they have created challenges for care facilities starting to engage in value-based models. Implemented in 2005, the ’25 percent’ rule penalizes long-term-care hospitals that admit more than 25 percent of Medicare cases from onsite or neighboring acute-care facilities.”

The letter said: “The continued application of FFS regulatory barriers within downside risk payment reform models often hinders providers’ ability to identify and place beneficiaries in the most clinically appropriate setting.  It also inhibits their ability to test new, more patient-centered and streamlined clinical pathways.”

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