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CMS Announces New Random Payment Generator

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Center for Medicare & Medicaid Innovation

By CMS and CMMI

CMS JUST ANNOUNCED a new Innovation Model from the Center for Medicare & Medicaid Innovation, the Random Payment Generator, which will launch as a demonstration in January 2017.

“We’re pleased to add an eighth category of Innovation Models to our innovation portfolio,”

says CMMI spokesperson Dr. Emmett Brown.

“We felt that with the wide range of models developed to date, we needed to develop a ‘placebo’ initiative that could be measured against the various concepts we have been testing. We’ll be able to better determine if simply taking random actions while facing the formidable challenges in purchasing and coordinating healthcare services yields any different results than the complex models we have undertaken.”

The Random Payment Generator will simply randomize payment amounts to be paid for billed services, based on an algorithm that has programmed into repurposed surplus portable equipment being distributed to Medicare Administrative Contractors. Doctor Brown explained that the older equipment has no Internet connectivity and thus is not susceptible to breaches from outside hackers.

CMS is seeking hospital and medical group applicants to participate in the one-year Medicare trial in which they may render services and submit billings without being subject to most provider program requirements, but will accept whatever payment amount is assigned by the Random Payment Generator as payment in full.

“A number of provider participants in our other models have complained that they can’t understand or find any logic in how they are getting paid, and the basis for payment under this new model will certainly be easier to communicate and understand,”

Doctor Brown continued.

***

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[A Random Payment Generator being shipped to Medicare Administrative Contractors]

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One Response

  1. Pilot Program Results Show Promise for New CMS Payment Model

    The CMS last week announced it is expanding the four-year pilot launched in October 2012. The federal government will engage public and private payers and about 20,000 providers in 20 regions. Just as before, providers will be encouraged to identify and work with patients who had multiple conditions that led to frequent doctor visits and hospitalizations. The clinics will be given monthly care-management fees for each beneficiary in addition to regular fee-for-service payments. The monthly amount will come whether or not a patient interacted with the practice that month.

    The practices will need to revamp their delivery care models to focus on five areas: access to and continuity of care; planned care for preventive and chronic needs; risk-stratified care management; engagement of patients and their caregivers; and coordination of care with patients’ other providers. In a New England Journal of Medicine article, Mathematica Policy Research evaluated the initiative’s first two years and found modest but impressive improvements. The pilot has not yet shown net cost savings, but reduced spending enough to almost cover the monthly care-management fees. These results should be interpreted with caution but are “promising and more favorable than might be expected,” according to the report.

    Source:
    Shannon Muchmore, Modern Healthcare [4/30/16]

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