Health Industry Leaders Applaud Over 170 Lawmakers for Letter Registering Concern over Scope, Potential Impact of Medicare, Medicaid Demonstration Projects

Letter States Center for Medicare and Medicaid Innovation Has “Exceeded Its Authority”; Mandatory Demos Could “Drastically Deteriorate Quality of Life” for Beneficiaries

WASHINGTON – Over 170 members of Congress have signed a letter to the Center for Medicare and Medicaid Services raising concerns over the size and scope of demonstration projects being carried out by the Center for Medicare and Medicaid Innovation (CMMI).  The Healthcare Leadership Council today applauded the letter and its message that CMMI demos must represent “true tests” of new healthcare payment systems rather than “wholesale changes to statute.”

The Healthcare Leadership Council (HLC) is a coalition of chief executives from the nation’s leading healthcare companies, representing all health sectors.

The letter, which HLC has actively urged lawmakers to support, cites three proposed demonstration projects announced over the past year: a requirement that at least 800 hospitals in 67 geographical areas participate in a new bundled payment model for hip and knee replacements; a mandatory new payment model for drugs administered in physician offices, affecting thousands of healthcare providers and millions of patients; and a bundled payment model for cardiac care that would be implemented in one-quarter of the nation’s metropolitan areas.

The lawmakers told CMS that the broad, mandatory demonstration projects could “create access issues for beneficiaries” and “can drastically deteriorate quality of care our seniors rely on.”

In the letter to CMS, members of Congress note that prior demonstration projects were implemented on a voluntary, limited-scale basis and providers and insurers were not mandated to participate.  They are urging the agency to cease all current and future mandatory CMMI initiatives and seek congressional approval if expansion of test models requires statutory changes.  The letter also urges officials to establish “an open, transparent process that supports clear and consistent communication with physicians, patients and other relevant stakeholders.”

HLC president Mary R. Grealy said, “We are strong supporters of CMMI and believe it is important to have a platform through which new ideas can be tested that move us closer to a value-based healthcare system.  With the lives and health of millions of patients at stake, though, it’s not prudent to put large-scale system changes in place without knowing how they will impact healthcare quality and patient outcomes. “