Three Republican Senators, Orrin Hatch of Utah, Michael Enzi of Wyoming, and Tom Coburn of Oklahoma, called on Thursday, November 10 for an examination by the Government Accountability Office, the investigative arm of Congress, into the activities and spending of the Center for Medicare & Medicaid Innovation, which was funded with $10 Billion under the 2010 health care reform law.
Under the Patient Protection and Affordable Care Act (“Affordable Care Act”), the health care reform law passed by Congress and signed by President Obama in 2010, the Center for Medicare & Medicaid Innovation (CMMI), under the Department of Health & Human Services (HHS), was provided a $10 Billion budget designed to test new ideas for cutting health care costs and improving quality of medical care. Health care professionals (as pictured above) are participating in several new pilot programs designed by CMMI to improve quality while lowering costs of health care.
The stated mission of the Center for Medicare & Medicaid Innovation (CMMI) is: “better care and better health at reduced costs through improvement. The Center will accomplish these goals by being a constructive and trustworthy partner in identifying, testing, and spreading new models of care and payment.”
But Senators Hatch, Enzi and Coburn said Thursday that they are now worried that the CMMI, with its $10 Billion budget, is a waste of money.
“We are concerned that at a time of significant uncertainty for the fiscal health of the U.S. government, funds are being expended by the Innovation Center with little to no actual value provided,” the senators wrote in a letter to Health and Human Services Secretary Kathleen Sebelius.
“Reducing health care costs is vital to preserving the solvency of the Medicare and Medicaid programs, but we are concerned that the Administration’s current approach, operating within the fee-for-service system, will not achieve the spending reductions necessary to meet this goal,” the Senators wrote.
The Center for Medicare & Medicaid Innovation (CMMI), however, is pursuing several of the administration’s most prominent initiatives to move away from the fee-for-service system.
What Programs are Funded by the Center for Medicare & Medicaid Innovation (CMMI)?
Among the notable programs that CMMI has established so far are:
- Partnership for Patients – An effort to reduce medical errors.
- Comprehensive Primary Care Initiative – A multi-payer initiative fostering collaboration between public and private health care payers and insurers to strengthen primary care for all Americans. This initiative will simultaneously test two models for improving primary care: (i) a Service Delivery Model, focusing on improving quality, access, preventive care, and coordination of care, and (ii) a Payment Model, which includes a monthly care management fee paid to the selected primary care practices on behalf of their fee-for-service Medicare beneficiaries and, in years 2-4 of the initiative, the potential to share in any savings to the Medicare program. For more detail, see HHS Announces Comprehensive Primary Care Initiative to Reward Better Coordination of Care.
- Bundled Payments for Care Improvement – A pilot program testing four different payment models, generally moving toward paying doctors and hospitals flat fees for treating patients, instead of our current fee-for-service model with separate payments for specific services. According to CMMI, “This initiative seeks to improve patient care through payment innovation that fosters improved coordination and quality through a patient-centered approach,” involving four broadly defined models of care, three of which “involve a retrospective bundled payment arrangement, and one model [which] would pay providers prospectively.” Participating providers may be entitled to share in any cost savings realized for Medicare under the program. Final applications of providers to participate in the program are due and must be received by November 18, 2011 for the Payment Model 1 program and by March 15, 2012 for Payment Models 2-4.
- Accountable Care Organizations (ACOs) – Creation of new coordinated-care groups called “Accountable Care Organizations (ACO’s).” As explained by CMMI, “ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.” Hospitals participating in the accountable care program may win as much as $1.9 Billion in bonus payments from Medicare if they can save the government money by streamlining, better coordinating and improving care.
- State Demonstrations to Integrate Care for Dual Eligible Individuals – A program to improve health care for “dual eligible” individuals, persons who are poor enough to qualify for Medicare and Medicaid.
- Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration – A program that will test the effectiveness of doctors and other health professionals working in teams to coordinate and improve care for up to 195,000 Medicare patients, to help patients manage chronic conditions, as well as actively coordinate care for patients for better health care results.
Questions Posed by the GOP Senators
Senators Hatch, Enzi and Coburn’s letter to Secretary Sebelius issued on Thursday, specifically asks for information about several of these CMMI demonstration programs that pay doctors to coordinate their services and focus on outcomes, rather than billing for each individual procedure they perform.
The Senators asked HHS how much money it has spent on those initiatives, including Medicare’s bundled payments program and the effort to create new integrated health programs through Accountable Care Organizations. They also requested information about whether those programs have produced any savings yet and how HHS is evaluating their success or failure.
Many of these new CMMI programs are in the early stages of being launched. HHS only recently finalized some of the regulations governing Accountable Care Organizations.
Senators Hatch, Enzi and Coburn also asked the Government Accountability Office for a detailed investigation into how the CMMI has been implemented and how it interacts with other agencies and offices.
A Hatch spokesman did not respond to questions posed by HealthWatch about the timing of the Senators’ letter and call for an investigation, which was released shortly after HHS scheduled an “important announcement” Monday regarding the Medicare Innovation Center.
The GOP Senators’ announcement, essentially seeking to challenge a portion of the Affordable Care Act by investigation, also comes just days after a Conservative-leaning three-judge panel of the U.S. Circuit Court of Appeals for the DC Circuit, specifically upheld the constitutionality of the Affordable Care Act and its individual insurance mandate as within Congress’ powers under the Commerce Clause of the U.S. Constitution. Some commentators have suggested that the DC Circuit Court’s opinion, written by a Conservative Judge appointed by President Ronald Reagan, may influence the U.S. Supreme Court and make it more likely that the High Court will uphold the Affordable Care Act.
The GOP Senators nevertheless maintained that their requested probe into the $10 Billion Medicare Innovation Center budget under the Affordable Care Act was driven by budgetary concerns with finding ways to cut federal government spending in the context of a looming report by the Congressional Super Committee charged with addressing the federal budget deficit.
The Senators, however, did not call for reductions in other areas of government spending and subsidies, such as tax subsidies given to the oil and gas industry, reported to range from $41 Billion to $ 72.5 Billion per year, federal subsidies to agriculture of approximately $15 Billion to $35 Billion annually, or military spending (with the proposed Department of Defense Budget for 2012 being $553 Billion).
For additional reporting on the GOP Senators’ call for investigations into the $10 Billion Center for Medicare Innovation, see links to several news reports provided by Kaiser Health News.
As to the HHS press release announcing an important announcement to be made on November 14 regarding the Medicare Innovation Center, see Affordable Care Act Announcement Supporting Health Care Innovation.
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