AAOE Member Practice Surgeon Testifies Before Congressional Committee
Tuesday, September 13, 2016
Posted by: Bradley Coffey, MA, AAOE Government Affairs
Washington, DC - A physician from an AAOE member practice that is participating in the Bundled Payments for Care Improvement (BPCI) program under Awardee Convener and AAOE member Signature Medical Group (St. Louis, MO) testified before the House Committee on the Budget on September 7, 2016. In the hearing titled Center for Medicare and Medicaid Innovation: Scoring Assumptions and Real-World Implications, orthopaedic surgeon Mark Madden, MD with OrthoVirginia in Fairfax, VA testified on his practice's participation in BPCI and the issues his and other practices have encountered in the program.
The hearing was held as a result of the Congressional Budget Office (CBO) informing members of the Majority in Congress that any alteration of Center for Medicare and Medicaid Innovation (CMMI) demonstration activities (CJR, CPC+, EPM, etc.) will be detrimental to the cost savings that these programs are working to achieve. Chairman Tom Price (R-GA), an orthopaedic surgeon chastised CBO in his opening statement, stating:
In its first five plus years of operation, CMMI has spent nearly $6.1 billion with no tangible savings yet to show for it. And, yet, CBO tells us that they expect the program to cover those expenses with savings by 2017. While at the same time, in its own Long-Term Budget Outlook, CBO has admitted that it does not know which, if any, of the current demonstration projects CMMI has embarked upon will result in savings.
Admittedly, there will always be a certain level of uncertainty in any estimates or projections. What concerns this committee and others is the certainty with which CBO’s analysis seems to project substantial savings by CMMI in the future. Those yet unrealized supposed savings make it a challenge for policymakers to propose changes to the program; which in turn, makes it challenging for policymakers to exercise our oversight authority.
Dr. Madden's comments focused on the achievements of the BPCI program, one of CMMI's voluntary programs, and its ability to cut costs while raising patient satisfaction and outcomes. He also discussed some structural concerns with the program including how the National Trend Factor (NTF), the multiplier used to update target prices from the previous quarter, is calculated. The calculation of the NTF has led to "unanticipated negative financial consequences" to many practices in spite of advancements in the quality of care provided to beneficiaries and makes participation in the programs less desirable. This then deprives beneficiaries of the high quality/low cost care these programs can encourage.