Biden’s health authorities are considering a variety of potential changes, from new constraints to complete dismissals, people familiar with the matter said.
Providers participating in the program are expecting a decision on Thursday, some of them told POLITICO. “We are cautiously optimistic that they will not stop the direct contract immediately and make some modifications to make it even better,” said the American representative of the direct contact provider. Valinda Rutledge, a healthcare lobbyist for a group of physicians, said.
A spokesperson for the Centers for Medicare and Medicaid Services said the agency is considering external comments on the global and professional direct contract model and that the agency will soon provide more information about the future of the program. rice field.
Internal reviews encourage lobbying from provider groups that support the direct contract model and eliminate it, wasting time and money spent by pilot participants, including medical groups and insurance companies, to adapt to that requirement. Insisted. This program is part of a long-standing bipartisan effort to shift providers from paid health care to new models that facilitate collaboration between providers and insurers...
Last year, CMS enrolled 53 organizations in the program. This is one of the few health policies the Trump administration has survived and is seen as a vote of public confidence that the administration plans to maintain it.
Signed by over 200 healthcare groups and healthcare providers Monday letter He appealed to the health sector to ensure the program’s survival, saying, “In the face of a recent pandemic, we have made constant efforts to move to a health care delivery and payment system that emphasizes quality and value.” Said.
Some program supporters have also warned that making changes now would hurt the reputation of CMS’s Innovation Center, the central incubator of new policies aimed at improving care. Within the CMS, one source said he would create a risky and frustrating policy staff and cancel the model year to encourage them to escape from the agency.
“If they make significant changes or cancel the model altogether, it will have a chilling effect,” said Darryl Drevna, senior director of regulatory issues at the medical industry group AMGA.
Despite widespread support for experimenting with the new provider model, the government was left with this particular program to allow private companies to manage the care of beneficiaries who first enrolled in traditional government-run Medicare. Faced with pressure.
Progressive has long individually criticized private insurers participating in the Medicare Advantage program for pushing up costs, and audits show that insurers regularly charge the government for health care. Is pointed out.
First application for direct contract program last April It also included many insurance companies and private equity funded companies. This was a development that violated the government’s broader goal of more efficient and enhanced care from liberal health groups.
National Health Program Physicians, Advocates for Single Payer Health, I sent a letter to HHS On Tuesday, he criticized the deal directly for “damaging” the position of the Innovation Center, adding that “terminating the program would show increased integrity and a commitment to the best interests of the beneficiaries.”
“We’re on a difficult path here,” said Donberwick, an Obama-era CMS administrator who supports program changes rather than eliminating them. “There is a mix of providers and insurance companies that we want to support, and in my opinion, we just add costs without adding value.”
Jayapal, who heads Parliamentary Progressive Caucus, led 50 lawmakers last month to call for a direct termination of the deal, which “privatizes traditional Medicare by injecting beneficiaries unknowingly.” Said it was a means.
Model variations have been scrutinized before.Last March, CMMI Check the direct contract model It was set up to test whether providers can improve care by managing care by region.
But the recent surge in criticism from prominent progressives is the strongest challenge ever for the program.
Mara McDermott, who represents the provider of the direct contract model for lobbying firm McDermott + Consulting, said:
