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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

CMS Releases RFI on Specialty Practitioner Payment Models

February 14, 2014—The Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) issued a request for information (RFI) to solicit stakeholder feedback on policy considerations for the development of innovative episode-based payment models and delivery programs focused on services provided by specialty practitioners in the outpatient setting. The AAMC will submit comments, which are due March 13, 2014.

CMMI seeks to build on the Bundled Payment for Care Improvement (BPCI) models that have been developed around inpatient episodes of care and to develop an episodic-based payment system for outpatient procedures furnished by specialty physicians who are primarily responsible for managing care throughout a Medicare beneficiary’s episode.

In developing a new payment model, CMS seeks input on how the episode should be initiated, which services should be included in the episode, and the episode’s duration. Episodes of care would likely also include the services for which specialist practitioners have control over and responsibility for, such as the choice of procedure, pharmaceuticals, site-of-service selections, imaging, and labs.

Additionally, CMMI requests feedback on the development of an episodic-based payment model designed to incentivize specialist practitioners to more efficiently manage the care of beneficiaries with complex or chronic conditions. This would include situations where the specialty practitioner is the primary caregiver and manager of care for the majority of care received by the beneficiary.

Contact:

Evan Collins, MHA
Specialist, Clinical Operations and Policy
Telephone: 202-828-0552
Email: ecollins@aamc.org

Mary Patton Wheatley, M.S.
Director, Health Care Affairs
Telephone: 202-862-6297
Email: mwheatley@aamc.org

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org