Assessing Alternative Payment Models —Reply

In Reply We agree with Mr Gondi and Dr Wadhera that CMS should use rigorous study designs in the evaluation of payment innovations. We have long supported the use of RCTs and mandatory enrollment to ensure rigorous evaluations. The original Comprehensive Joint Replacement program is one excellent example. Unfortunately, the Trump administration subsequently removed the mandatory randomized design by allowing hospitals to drop out of the program. All of the example evaluation designs proposed by Gondi and Wadhera (cluster, stepped-wedge, and adaptive) would be improvements compared with the usual voluntary programs with observational studies that make interpretation of changes in outcomes suggestive rather than definitive. Ultimately, RCTs will minimize the need for speculation by evaluators, policy makers, and participants.
Source: JAMA - Category: General Medicine Source Type: research