On November 1st, the Centers for Medicare and Medicaid Services (CMS) published the agency's final 2020 Quality Payment Program (QPP) rule that announced beginning in 2021 CMS will begin instituting MVPs, or Merit-based Incentive Payment System Value Pathways. These value pathways will be created to financially incent and reward, as CMS states, “high value clinicians.” This means CMS will begin to measure and financially reward Medicare physician performance based on value or spending efficiency defined as outcomes achieved relative to spending. MVPs may prove to be a significant Medicare payment policy reform. This is because while Medicare program officials have implemented numerous "value-based payment" programs and demonstrations since the passage of the 2010 Affordable Care Act, these arrangements financially reward either quality - or - reduced spending growth, they do not reward “value” or spending efficiency. In addition, as recently noted by Harvard’s Ashish Jha and his colleagues in a October 9th JAMA "Viewpoint" essay, these current "value-based payment" programs have not had large effects on quality improvement. (Listeners may recall I discussed measuring for health care value or spending efficiency with University of Michigan Professor Andrew Ryan this past May 11th and in later May posted on the podcast website a related essay I wrote for Bloomberg Law.)
During this 30 minute conversation Dr. Goodrich discusses in sum CMS' proposal to implement beginning in 2021 Merit-based Incentive Payment System Value Pathways (MVPs). She explains the rationale for using of global and population health measures and patient-reported outcome measures (PROMs) and how the agency will measure or evolve its MVP-related cost measures. She discusses MVPs potential to increase provider productivity, the potential MVPs have in helping to harmonize Medicare three payment silos: fee for service, Accountable Care Organizations (ACOs); and, the Medicare Advantage (Part C) program, in influencing commercial insurance plans' payment policies through CMS' HCPLAN (the Health Care Payment Learning Action Network), and discusses the relevance or importance of social determinates or measures thereof in driving Medicare value.
Dr. Kate Goodrich is currently the Director of the Center for Clinical Standards and Quality (CCSQ) and CMS Chief Medical Officer (CMO). This Center is responsible for 18 quality measurement and value-based purchasing programs including the Quality Payment Program, quality improvement programs in all 50 states, clinical standards and survey and certification of all providers across the nation, and coverage decisions for treatments and services for CMS. The Center budget exceeds $1.2 billion annually. Prior to being CCSQ director and CMO, Dr. Goodrich served as the director of the Quality Measurement and Value-based Incentives Group in CCSQ from 2012 through 2015. She graduated from the Robert Wood Johnson Clinical Scholars Program at Yale University in 2010. From 1998 to 2008, Dr. Goodrich was on the faculty at the George Washington University Medical Center (GWUMC) and served as division director for Hospital Medicine from 2005 to 2008. She went to medical school at Louisiana State University in Shreveport, Louisiana, and completed her internal medicine residency and chief medical resident year at GWUMC. She continues to practice clinical medicine as a hospitalist and professor of medicine at GWUMC.
The Quality Payment Program final 2020 rule that discusses MVPs is at: https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other.
Information on the HCPLAN is at: https://hcp-lan.org/.
The Bloomberg Law essay is, again, at: https://news.bloomberglaw.com/health-law-and-business/insight-containing-health-costs-requires-measuring-rewarding-spending-efficiency.