GAO: CMS Risks Duplication with its Many New Payment/Treatment Models
The Centers for Medicare and Medicaid Services is operating multiple programs, many of them mandated under the health reform law, to test new payment and treatment delivery models. But better coordination among the programs is needed, according to the Government Accountability Office in a new report.
The Centers for Medicare and Medicaid Services is operating multiple programs, many of them mandated under the health reform law, to test new payment and treatment delivery models. But better coordination among the programs is needed, according to the Government Accountability Office in a new report.
At issue is the possibility of inefficient use of federal resources, the GAO contends, and the need for CMS to ensure it does not pay for the same service under multiple programs. CMS has initiated a process to make sure this does not occur, and GAO has recommended an expedited review to eliminate any areas of unnecessary duplication, to which CMS agreed.
GAO looked at 17 new models that The Center for Medicare and Medicaid Innovation has implemented in test environments covering such payment models as accountable care organizations and shared savings, and quality programs such as reducing hospital-acquired conditions and reducing 30-day hospital readmission rates. But there is overlap among the innovation center programs and other similar CMS programs, GAO found.
“GAO identified three key examples of overlap between the 17 Innovation Center models and the efforts of other CMS offices, meaning that the efforts share similar goals, engage in similar activities or strategies to achieve these goals, or target similar populations,” according to the report. “However, these overlapping efforts also have differences, and CMS officials said the efforts are intended to be complementary to each other.”
For instance, the Innovation Center is implementing two ACO models--Pioneer and Advance Payment--that share similar goals with the Shared Savings Program that the Center for Medicare is operating. But the two centers have different approaches to sharing any realized savings, GAO notes.
Another example: The Innovation Center is testing Medicaid payment models, but so is the Center for Medicaid and CHIP Services, with differences in testing the effectiveness of the approaches. There also are similarities in quality programs operated by the innovation center and the Center for Clinical Standards and Quality.
The GAO report, “CMS Innovation Center: Early Implementation Efforts Suggest Need for Additional Actions to Help Ensure Coordination with Other CMS Offices,” is available here.
At issue is the possibility of inefficient use of federal resources, the GAO contends, and the need for CMS to ensure it does not pay for the same service under multiple programs. CMS has initiated a process to make sure this does not occur, and GAO has recommended an expedited review to eliminate any areas of unnecessary duplication, to which CMS agreed.
GAO looked at 17 new models that The Center for Medicare and Medicaid Innovation has implemented in test environments covering such payment models as accountable care organizations and shared savings, and quality programs such as reducing hospital-acquired conditions and reducing 30-day hospital readmission rates. But there is overlap among the innovation center programs and other similar CMS programs, GAO found.
“GAO identified three key examples of overlap between the 17 Innovation Center models and the efforts of other CMS offices, meaning that the efforts share similar goals, engage in similar activities or strategies to achieve these goals, or target similar populations,” according to the report. “However, these overlapping efforts also have differences, and CMS officials said the efforts are intended to be complementary to each other.”
For instance, the Innovation Center is implementing two ACO models--Pioneer and Advance Payment--that share similar goals with the Shared Savings Program that the Center for Medicare is operating. But the two centers have different approaches to sharing any realized savings, GAO notes.
Another example: The Innovation Center is testing Medicaid payment models, but so is the Center for Medicaid and CHIP Services, with differences in testing the effectiveness of the approaches. There also are similarities in quality programs operated by the innovation center and the Center for Clinical Standards and Quality.
The GAO report, “CMS Innovation Center: Early Implementation Efforts Suggest Need for Additional Actions to Help Ensure Coordination with Other CMS Offices,” is available here.
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