Two federal initiatives, CMS’ AHEAD model and the Rural Health Transformation Program, could help move physician payment toward rewarding outcomes over volume, according to a Sept. 24 Commonwealth Fund blog post by Lauren Testa, senior vice president of Impact Health Policy Partners.
The analysis comes as Congress weighs bipartisan Medicare reforms that would tie physician pay to patient outcomes instead of service volume. Ms. Testa argues that more than a decade of payment reform experience shows financial incentives alone do not ensure success.
“Payment models can create incentives for greater accountability, but providers also need the workforce, technology, care management capabilities, governance structures, and operational ability to respond to them,” Ms. Testa wrote.
The CMS Innovation Center is testing AHEAD, short for Achieving Healthcare Efficiency through Accountable Design, as a comprehensive state-led payment model. It gives states a common federal framework for statewide reform. States must align Medicaid and commercial payers and build governance structures.
Congress created the Rural Health Transformation Program as a temporary program. It gives states resources for infrastructure and changes to how care is delivered. Provider payments are capped at 15% of each state’s award, and technology and administrative spending face separate caps. The program also uses phased funding and annual performance reviews.
Ms. Testa pointed to two states already linking the programs. Georgia is using its rural health funds to prepare rural providers to join AHEAD later. Maryland is pairing its rural health investments with its existing AHEAD strategy.
The analysis concludes that both initiatives show why provider capacity has to be built alongside new financial incentives.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
