Secretary Burwell Throws Down the Gauntlet

On January 26th, Secretary Burwell laid out an ambitious goal of having “30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide – and to do it by 2016.Our goal would then be to get to 50% by 2018.”

See her blog post on the topic here.

She continues, “Our second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and 90% in 2018.” Hmmm. More than 20% of fee-for-service payments are for rural beneficiaries, yet RHCs, CAH’s and FQHC’s are the only providers whose payments are not tied to quality and value. No PQRS, no value-based purchasing, no value-based modifiers, not even Medicare Meaningful Use. How will the Secretary achieve her goal without offering incentives for rural providers? As one CEO wrote to me yesterday, the times they are a’changin.

Expect more to come from HHS. We’d like to help the Secretary achieve her goal with better incentives for rural providers to participate in ACOs. Better payments, better assignment, more flexibility and having Medicare pay residual cost-sharing for our seniors to encourage them to get care in their rural ACO would go a long way.

Please review our comments letter here.  If you agree, go to and send in a comment on CMS-1461-P supporting our ideas. Comments matter! And so do rural beneficiaries!