CMS Demands Value

September 16, 2019 By: Bob Atlas, President & CEO

Last week AHA held a biennial national meeting of all nine Regional Policy Boards. CMS Administrator Seema Verma spoke on the final day, delivering strong words on the federal government’s push toward value-based payment.

“We must move past the status quo, and past a fee-for-service payments to a system in which we’re paying providers to keep people healthy, reduce costs and deliver better outcomes,” she noted.  

And with hospital care representing one-third of all health expenditures, she continued, “… for our health care system to drive down total costs, our models will have to get at hospital spend. So, make no mistake—if your business model is focused merely on increasing volume rather than improving health outcomes, coordinating care and cutting waste, you will not succeed under the new paradigm. As the market moves to more value-based payment, and as participants demonstrate success, at some point models will no longer become optional and will become standard payment policy.”

Don’t those remarks sound like an affirmation of the Maryland Model? With global budgeted revenue, quality-based payment, and incentives on total cost of care, our model fills the bill–in the hospital space–and it is already standard policy across Maryland.

Administrator Verma also sent some warnings hospitals across the nation should heed. “Americans are fed up, not only are they paying more, but they aren’t being treated fairly. Like when they go to a hospital they think is in-network, and then receive bills from out-of-network providers. One in six patients have experienced surprise bills after a hospital stay, even when they have insurance. This is simply not fair to patients.” Also, “… certain not-for-profit hospitals…are referring patients to debt collectors, garnishing wages, placing liens on property, and even suing patients into bankruptcy. This is unacceptable. Hospitals must be paid for their work, but it’s actions like these that have led to calls for a complete Washington takeover of the entire health care system.”

So, let’s redouble our ongoing efforts to ensure patients also feel the benefits when their bills come due. At the same time, let’s be proud of what we’ve accomplished in Maryland and continue to educate policy-makers on the value of our model.