CMS Enhanced Payments for High Quality Primary Care

CMS announced a demonstration project, the Comprehensive Primary Care Initiative (CPCI), under which 45 commercial, federal and state insurers in seven markets have agreed to make enhanced payments to primary care practices that provide high-quality care.  The Center for Medicare and Medicaid Innovation (CMMI) will pay primary care practices a care management fee of $20 per beneficiary per month to support enhanced, coordinated services in the first and second year and $15 in the third and fourth years.

PCORI Report on Comparative Effectiveness

The Patient-Centered Outcomes Research Institute unveiled a methodology committee draft report containing proposed standards and research methods that future applicants for PCORI funding can use to develop comparative effectiveness research.  Applications for the first round of funding are due July 31st.

Health Insurance Exchange Enrollment and Assistance

A CMS collaboration with 13 states, 8 charitable foundations and a design firm have developed a self-service online enrollment process for health insurance exchanges.  The design will be made available at no cost to all states and the federal government to customize as they may need.  In another instance, HHS announced it will grant $30 million under the PPACA Consumer Assistance Program (CAP) to support state-based health insurance consumer assistance or ombudsman programs.  Applications are due July 9th.

Medicaid Fraud Efforts and CMS Medicare Contractors Come Under Fire

The House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing which the subcommittee said was to obtain more information on why CMS lacks accurate data on the performance of Medicare program integrity contractors.  Chairman Stearns said that “complacency shown by CMS toward this committee’s oversight efforts, their repeated indifference to GAO’s recommendations since, and their disregard for the HHS OIG’s extensive body of work in this area must end today.”  In a hearing held by the House Committee on Oversight and Government Reform Subcommittee on Government Organization, Efficiency and Financial Management, the office of the HHS OIG said there have been significant shortcomings in the data available to conduct efficient, national Medicaid program oversight via data analysis and data mining.  As in the first hearing, CMS’ operation of its Recovery Audit Contractor (RAC) program was also criticized for failing to recover improper Medicare payments.

New CMS Data Office

CMS announced the creations of a new office, the Office of Information Products and Data Analysis (OIPDA), that is designed to modernize the use and dissemination of data and information as value based purchasing becomes more prevalent under Medicare and Medicaid in the post PPACA world.  In another data move, HHS announced that it asked for OMB approval to collect more information on SCHIP programs in all states leading up to the implementation of the PPACA.

MD Members Seek Time to Reform SGR

Republican House Doctors Caucus members Tom Price and Charles Boustany, Jr. have announced plans to introduce legislation which would provide for annual Medicare physician payment updates, based on a medical index, over five years during which a new payment system would be developed to replace the flawed current payment system.

ESRD Network Standards

CMS announced that it has redesigned the ESRD network statement of work (SOW) to incorporate new priorities in health care, including establishing relationships with patients, families and facilities.  The three goals are: Better Care for the Individual through Beneficiary and Family Centered Care; Better Health for the ESRD Population; and Reduce Costs of ESRD Care by Improving Care.

CBO Publishes Health Expenditure Growth

CBO issued a report, the 2012 Long-Term Budget Outlook, which includes estimates that federal health care program spending will increase from more than 5% of GDP today to almost 10% of GDP in 2037 with Medicare growth likely to outpace Medicaid’s.  The report also said the high rates of growth cannot continue indefinitely or health care spending would eventually consume all of the United States’ economic output.  The White House also issued a report on the President’s executive order mandating the review of regulations in an effort to reduce unnecessary burdens.  It said HHS will soon propose new revisions which are estimated to save $4 billion over five years by reducing burdens on hospitals and other health care providers.

December 31, 1969: | Page 1 Page 2 Page 3



 -  2019

 +  2018