November 06, 2017
On November 3, 2017, the Innovation Center released Report to Congress: Episodic Alternative Payment Model for Radiation Therapy Services. Section 3(b) of the Patient Access and Medicare Protection Act (PAMPA) (P.L. 114-115) directs the Secretary of Health and Human Services to submit a report to Congress on the development of an episodic alternative payment model (APM) for Medicare payment. The report is available here.
Several alternative payment model design considerations, including the type of alternative payment model; how the model is expected to result in clinical practice transformation; the rationale for such a model; the potential scale; its alignment with other initiatives; how the model may measure improved clinical quality and patient experience; and, how readily providers may participate were presented.
The report concludes that CMS would need to consider these issues before moving forward with any future episode payment model on radiation therapy services and continue to seek input from stakeholders on these important issues.
In additional Innovation Center news, with the release of the 2018 Medicare Final Physician Fee Schedule, CMS finalized the implementation of the expansion of the Medicare Diabetes Prevention Program. This model is an expansion of the Diabetes Prevention Program model, which was tested through the Innovation Center’s Health Care Innovation Awards. The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of prediabetes. A fact sheet on the program is available here.