Patient, provider groups urge CMS to reinstate risk adjustment payments

Patient and nurse in hospital
Physician organizations, including the AMA, said the risk adjustment freeze limits access to care. (Getty/monkeybusinessimages)

Some of the nation's largest hospital and provider groups are speaking out against the Trump administration's decision to freeze risk adjustment payments.

A total of 28 medical organizations, including the American Medical Association (AMA), the American Hospital Association and the American Academy of Family Physicians, urged the Centers for Medicare & Medicaid Services (CMS) to reconsider its decision to suspend risk adjustment payments in a letter (PDF) sent to Administrator Seema Verma on Monday.

“We are very concerned that this move will create further uncertainty in the marketplace, negatively impacting patients’ access to affordable and comprehensive coverage, and lead to higher premium increases next year,” the letter reads. “CMS’ decision to delay these [payments] jeopardizes patients’ ability to access affordable coverage as well as lifesaving care and treatment.”


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

Five physician organizations signed the letter, including the AMA. Last week, six physician organizations released a statement denouncing this decision as well; two of those groups also signed this week’s letter.

RELATED: Blues plans crushed by risk adjustment freeze as Kaiser skirts nearly $1B

The undersigned also includes nineteen organizations that advocate for specific patient populations, two hospital organizations, and one social service organization.

CMS announced it would put risk adjustment payments on hold earlier this month, citing a federal district court ruling that said the agency’s methodology to calculate the payments was flawed.

RELATED: Fitch: Risk adjustment freeze won’t hurt credit ratings for the largest insurers

The letter recommended the agency “seek other possible options to resolve the issues raised by the New Mexico risk adjustment litigation,” such as issuing an expedited rule justified the same way as the 2019 risk adjustment payment methodology.

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