Illustration: Annelise Capossela/Axios
House Energy and Commerce Republicans grilled the head of Medicare's Innovation Center on Thursday over how efforts to eke out savings through new payment models actually drove up health spending.
Why it matters: It turns out that voluntary participation in arrangements to make providers financially accountable for delivering more efficient care may be slowing progress towards value-based care.
Driving the news: The Energy and Commerce health subcommittee focused on the Center for Medicare and Medicaid Innovation and value-based care arrangements after CBO reported last year that CMMI actually increased federal spending by $5.4 billion between 2011 and 2020.
- That amounts to 0.1% of net Medicare spending.
Where it stands: In most cases, providers can drop out of a model if they start losing money, which can lead to risk selection, Liz Fowler, the center's director, told lawmakers.
- CMMI proposed two new mandatory models this year, including one that tests a new payment system for certain kinds of surgical care.
What they're saying: "Every model, the ones that predated my time here and the models that we've announced and are implementing, all go into the field with an expectation of potential savings, otherwise they they wouldn't be approved to go out the door," Fowler said.
Zoom out: GOP lawmakers remain skeptical that CMMI lives up to its mission, but they aren't calling for it to be dismantled.
- "While I have concerns on the overall direction and lack of results with CMMI, there have been a few positive outcomes that deserve to be recognized," Energy and Commerce Chair Cathy McMorris Rodgers said.
- Accountable care organization models "are among the few that have actually managed to reduce overall spending and should not be abandoned," she said.
