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CMS innovation center faulted for wasteful duplication

Government investigators report that there appears to be overlap between agencies overseeing health programs and the relatively new Center for Medicare & Medicaid Innovation.

The Government Accountability Office found instances in which similar multimillion-dollar programs exist in the Obama administration and urged in a report published on Dec. 21, 2012, that they be coordinated better. The Dept. of Health and Human Services, which oversees the innovation center, has championed the testing of new health care payment and delivery models that could lower federal health spending in the Medicare and Medicaid programs.

GAO reviewed the innovation center’s funding and organization as of March 31, 2012. The report detailed the center’s plans for evaluating new models and examined whether there is overlap with activities by the Centers for Medicare & Medicaid Services.

The innovation center had hired 184 employees to work in four groups overseeing the testing of 17 models designed to improve the quality of care and deliver it at a lower cost. About $3.7 billion will be needed to fund the center’s various projects, which range from $30 million to $931 million.

Auditors found three examples of duplication, along with a number of processes that could be improved through better coordination and collaboration. Those examples were accountable care organization programs that reward physicians and hospitals for improving quality and lowering costs; new models to deliver and pay for health care in Medicaid; and the public health initiative partnership for patients that aims, for instance, to lower rates of hospital-acquired conditions.

GAO recommended that CMS direct the innovation center to complete implementation of an internal process to review and eliminate unnecessary duplication in hospital programs. HHS concurred with the recommendation, but it noted that only one of the three examples cited in the report was at risk of creating wasteful duplication of efforts.

For instance, GAO had concerns about overlap between the testing of new Medicare payment models — the Medicare shared savings program and the innovation center’s pioneer and advance payment accountable care organization programs.

Pioneer ACOs and advance payment ACOs “were carefully and explicitly designed to be complementary to participate in MSSP,” HHS officials wrote in a Nov. 2, 2012, memo. “The pioneer ACO model is a discrete initiative; as such, providers who participate in a pioneer ACO are not permitted to also participate in MSSP. Therefore, there is no potential for overlap.”

The full and original article can be found at: http://www.ama-assn.org/amednews/2012/12/31/gvse0104.htm

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