The CMS Innovation Center in the Centers for Medicare and Medicaid Services is responsible for establishing new alternative payment models such as Accountable Care Organizations, bundled payment initiatives, payment based on episodes of care, and models that transform primary care in an effort to move away from the original Medicare fee-for-service program and improve quality and care while lowering costs.
In November 2017, CMS announced plans for the Center’s move in a new direction to promote patient-centered care, empower beneficiaries as consumers, increase competition, and increase choices and competition to drive quality, among other things. The agency announced eight potential models under consideration and requested information from interested stakeholders on ideas and concepts for the future direction of the Center. Two potential models were of interest to AARC — the Physician Specialty Model and Medicare Advantage (MA) Innovation Model. We provided comments to CMS recommending the establishment of a voluntary model that would pay separately for chronic disease management services, including self-management and training, furnished by respiratory therapists in pulmonologists’ offices with an incentive payment to the physician if the services reduced emergency department visits and hospital readmissions. We also recommended the lifting of certain telehealth restrictions through waivers that would permit Medicare Advantage plans to offer chronic disease management telehealth services furnished by respiratory services as a supplemental benefit which could give the MA plans a competitive edge in reaching individuals in rural and low income areas. Improved access to respiratory therapists in these models can help meet the CMS’ goals.