CMS to Reward Providers that Ration Care

The Patient Protection and Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to move to a system that pays health care providers based on the cost and quality of the care they provide. At a Sept 24th meeting at the CMS headquarters in Baltimore, agency staff told stakeholders it had little choice but to base its value indicator on claims data because it has yet to develop a better metric for value. Representatives of doctors and hospitals expressed concerns that CMS would use claims data as an excuse to reduce reimbursements. The implication is that CMS could penalize high volume providers and cut their payments while rewarding doctors and hospitals that ration care.

Comments (12)

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  1. Devon Herrick says:

    One problem with top-down cost containment policies is the only mechanism they know is to squeeze the providers. Bureaucrats believe they can simply cut physician fees and doctors won’t respond with more volume or dropping out.

  2. Tom says:

    Here’s an update on ye olde post when you talked about child-only policies.

    Thought you should know.

  3. John Goodman says:

    Thanks for the update, Tom. We need to do a separate post on that.

  4. Bruce says:

    Are we supposed to be surprised at this? It’s what I expected all along.

  5. Tom says:



  6. Virginia says:

    After all that talk about quality, now we’re back to square one.

  7. steve says:

    So you are ok with facilities that do many more procedures with outcomes that are no better or actually worse? I call that subsidizing poor care. You call stopping that rationing.


  8. steve says:

    Sigh. I actually went and read the linked article. No where did I see the word ration. This is actually an article about how to determine quality.


  9. Tom H. says:

    Steve, Medicare is going to reward “efficient” doctors and punish “inefficient” ones. But the only information it will use is billing data. There are no independent measures of quality. So doctors who do less (ration care) will always appear to be more efficient.

  10. steve says:

    Tom- Read the article. The whole thing is really about how to determine quality measures.


  11. Devon Herrick says:

    Steve, the article does discuss the need for quality metrics to be weighed against costs. But it also states in several places CMS does not have quality metrics yet. All they have to work with is claims data. There are no quality metrics associated with claims data — just volume. If you’re required to compare cost and quality; but all you have to work with is cost data, your decisions would reward lower cost.

  12. steve says:

    @Devon- True. That appears to be why they held the meeting. To figure out what metrics should used in determining quality and how that will be communicated.

    ” cost data, your decisions would reward lower cost.”

    I thought that they were looking mostly at utilization.