CMS terminates 4 Medicare pay models ahead of schedule
Read Article: Modern Healthcare
Article Summary: The Centers for Medicare and Medicaid Services (CMS) has announced the early termination of four Medicare payment models, which were set to run through 2025 or beyond. The models affected include Primary Care First, Making Care Primary, End-Stage Renal Disease (ESRD) Treatment Choices, and Maryland Total Cost of Care. Additionally, CMS is scaling back its Integrated Care for Kids model in Medicaid and CHIP. These decisions signal a shift in CMS's approach to healthcare payment models, with a focus on chronic disease management, evidence-based practices, and cost containment. As a result, healthcare providers and organizations must adapt to the uncertainty and potential changes in reimbursement structures, care coordination, and payment strategy moving forward. This move could affect hospitals, physician groups, and other healthcare stakeholders involved in Medicare and Medicaid.
The Risk:
Disruption of Value-Based Payment Models: The early termination of Medicare payment models disrupts existing value-based payment structures, forcing healthcare organizations to adjust their reimbursement strategies. These disruptions could impact financial stability and care coordination efforts, particularly in primary care and chronic disease management. (Area: Revenue and Reimbursement) (Category: Federal Regulations)
Uncertainty in Primary Care Funding: The cancellation of Primary Care First and Making Care Primary models leaves primary care providers without reliable funding and reimbursement mechanisms designed to improve care delivery and coordination. This uncertainty could hinder efforts to improve primary care access and quality. (Area: Revenue and Reimbursement) (Category: Federal Regulations)