Whether a provider participates in one of CMS' bundled payment models is influenced by their likelihood of financial gain, according to a report publicly released by the Government Accountability Office Jan. 22.
Four things to know from the 44-page report, which was initially published Dec. 21:
1. CMS tested or was in the process of testing six episode-based payment models as of February 2018. Of these models, all but one were voluntary.
2. Stakeholders interviewed by the GAO said voluntary models largely benefit providers, as they tend to have more generous terms. They also allow providers to only participate in the models they are likely to achieve success in.
3. Comparatively, providers in mandatory models have limited options to end their participation if they can't meet model requirements. Some stakeholders suggested to the GAO that this could adversely affect patient care, as well as their financial picture.
4. Still, CMS is more likely to glean generalizable results from mandatory models. Mandatory participation allows CMS to "test models with greater financial risks and penalties because providers are required to participate. CMS can encourage transition from traditional Medicare to value-based care models among providers that may be reluctant to make the change on their own," the report states.
Access the full GAO report here.
More articles on healthcare finance:
Ohio hospital faces closure after losing Medicare certification
HCA reportedly selling $1B in debt to aid Mission Health acquisition
CMS updates 2 payment models for Medicare plans: 7 things to know