CMS Doubling Down on Health IT; Patients - CMS Blog

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services

Americans enjoy the benefits of the best healthcare providers and innovators in the world. Yet while the volume of care consumed by American patients has not increased dramatically comparative to similar economies, the cost of care in the United States has accelerated at an alarming pace. Healthcare costs continue to grow faster than the U.S. GDP, making it more difficult with each passing year for CMS to ensure healthcare to not only its beneficiaries of today, but generations of beneficiaries in the future.

We believe at CMS that a major cause for the cost inefficiency of healthcare is attributable to a failure in the past to make the system about the patient and for the patient. It is the system that has become the centerpiece of policy debates, and it is the system that has become more about sustaining itself than serving patients. If the patient truly is what our healthcare system seeks to serve, then the patient must be the focal point of all policies and private industry decision-making.

CMS is committed to leveraging innovation to truly empower patients with their own data, decisions, and care. Evidence of this commitment can be found in a government-wide initiative launched by CMS and the White House Office of Innovation in March called MyHealthEData— designed to achieve true patient control and interoperability of their health records, and to enable patients to share their data with technology innovators and researchers to accelerate public health. See our new video for a simple explanation of MyHealthEData.

At CMS we are putting patients first, and we are moving to break down silos of patient information that is being captured by the system, and depriving the patient the access to the best quality, and most affordable care. Sustaining our exceptional healthcare depends now more than ever on driving down costs, and a major part of the CMS strategy to drive down costs depends on smart and innovative use of information technology (IT).

Through MyHealthEData, CMS envisions a future in which all patients have access to their own health data and use it to make the right decisions for themselves and to get the best value. We see health IT systems that work seamlessly with each other, and a government that supports secure data sharing and emerging technologies so that healthcare in America is better and less expensive.

To achieve these goals, CMS fully acknowledges that we cannot operate in a “way-we-have-always-done-it” manner and hope for different results. That is why CMS created the new role of CMS Chief Health Informatics Officer (CHIO) and has begun the process of filling this new role with a leading healthcare IT talent. The CHIO will drive health IT and data sharing to enhance healthcare delivery, improve health outcomes, drive down costs, and empower patients. Through this new function, CMS will effectively engage stakeholders from all parts of the healthcare market, including our Federal partners and industry leaders.

As CMS Administrator, I am deeply committed to programs, policies, and systems that put patients first. It’s 2018—most doctors are using electronic health records (EHRs) and most patients have access to the Internet and a smartphone, providing many ways to view healthcare data securely. Patients should expect health IT that enhances their care coordination instead of disrupting it. Their information should automatically follow them to all of their healthcare providers, so that everyone stays informed and can provide the best treatment. Patients also should know how much a health service costs so they can decide whether they want it, and “shop around” for where to get it.

Another reason behind our decision to create a CHIO role is that today at CMS, we are focused on data, not only to inform our strategy, but also to promote patient choice and drive down cost. We are evaluating the data we have and how best to apply it to our mission. We also are thinking about an Application Programming Interface (API) strategy across the entire agency that will allow us to securely provide data so that software developers, researchers, and others can design useful products (such as apps) powered by it, just as so many companies do to enhance their customer experience.

If we can solve these health IT challenges, not only will patients benefit, but so too will providers and payers. We are closer than ever to realizing these goals, but we are not there yet.

The truth is, as the largest healthcare payer in the country, CMS should have had a CHIO function long ago. Despite today’s amazing technology and decades of promises, we are not where we should be. The CHIO role will enhance my leadership team, working across CMS, with federal partners including the U.S. Digital Service, and alongside private industry and researchers to lead innovation and help inform CMS’s health IT strategy. The challenge is great, but so is the reward—building the next generation of interoperable health systems for millions of Americans and affecting national and global health IT for good.

We now have the momentum and focus to make this happen.

Although we will refine specific responsibilities, we anticipate the CHIO role will help drive forward the many health IT initiatives we have begun this year, including the Medicare Blue Button 2.0 program—a universal digital format for personal health information—and our overhaul of the CMS EHR Incentive Programs to focus on interoperability.

I look forward to meeting qualified CHIO candidates who wish to step up to this challenge and join the team that will lead CMS health IT over the “finish line” so that we can drive down costs and save lives. The time is now to realize the true potential of health IT for America’s patients.

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CMS Opioids Roadmap - CMS Blog

Although some progress has been made in efforts to combat the opioid epidemic, the latest data from the Centers for Disease Control and Prevention indicate the crisis is not slowing down. However, it is important for our beneficiaries across the country to know that the Centers for Medicare & Medicaid Services (CMS) is exploring all of our options to address this national crisis.

As evidence of our commitment to the health and well-being of patients, CMS is publishing a roadmap outlining our efforts to address this issue of national concern. In this roadmap, we detail our three-pronged approach to combating the opioid epidemic, focusing in on prevention of new cases of opioid use disorder (OUD), the treatment of patients who have already become dependent on or addicted to opioids, and the utilization of data from across the country to target prevention and treatment activities.

Current estimates show that over two million1 people suffer from opioid use disorder, with a prevalence in Medicare of 6 out of every 1,000 beneficiaries.2 In order to decrease that number, it is crucial that Medicare beneficiaries and providers are aware that there are options available for both prevention of developing new cases of OUD and the treatment of existing cases. CMS is working to ensure that beneficiaries are not inadvertently put at risk of misuse by closely monitoring prescription opioid trends, strengthening controls at the time of opioid prescriptions, and encouraging healthcare providers to promote a range of safe and effective pain treatments, including alternatives to opioids. We are also working on communications with beneficiaries to explain the risks of prescription opioids and how to safely dispose of them, so they are not misused by others. These are just some of the ways we are looking to protect and care for people with Medicare.

1 https://www.hhs.gov/opioids/about-the-epidemic/index.html

2 https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

CMS also recognizes that the opioid epidemic has affected people covered by Medicaid across the country in different ways – an estimated 8.7 out of 1,000 Medicaid beneficiaries are impacted by OUD. We believe one crucial effort to help on the treatment front is encouraging states to tailor programs to their populations by taking advantage of flexibilities that are available through Medicaid Section 1115 substance use disorder (SUD) demonstrations that improve OUD treatment. CMS has worked with seven new states since October 2017 to approve waivers to tackle the opioid epidemic in their state. With each state having a unique population, we recognize the challenges that states face in creating programs to help, and we are committed to providing the support necessary to help states achieve positive results for their populations.

Beyond Medicare and Medicaid, CMS is also looking across our other programs to use all the tools at our disposal to address the opioid crisis. We are working to ensure that the private plans offering coverage on the Health Insurance Exchanges also provide options for treating OUD, and we are examining our quality standards across our programs to encourage providers to follow best practice guidelines related to opioid misuse diagnosis and treatment. Further, while we have initiatives specific to Medicare and Medicaid, we are also reviewing all of our programs to find solutions that are working at the local level with states, providers, and payers so that we can

disseminate successful ideas as quickly as possible to help our partners know that they do not have to solve this alone.

CMS believes we can make progress in addressing the many aspects of the opioid epidemic in partnership with states and other stakeholder organizations. Every day this crisis claims the lives of loved ones and, in many areas in our country, we have yet to turn the tide. This roadmap is only a start, and as we begin to implement many of our plans and programs, it will continue to evolve. But the roadmap is also a demonstration of CMS’ commitment to explore and offer viable options to address the crisis, to share the information we collect with other agencies and organizations, and to protect our beneficiaries and communities affected by the crisis.

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A New Era of Accountability and Transparency in Medicaid - CMS Blog

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services

In his first 500 days in office, President Donald J. Trump has achieved results both at home and abroad for the American people, working to ensure government is more accountable to the American people. One of the many promises the Trump Administration has made and kept is improving accountability and transparency in Medicaid.

Medicaid provides healthcare for more than 75 million Americans, including many of our most vulnerable citizens, at an annual cost of over $558 billion. It has grown significantly over the years, consuming an every greater share of our public resources – from 10 percent of state budgets in 1985 to nearly 30 percent in 2016. Medicaid should improve the lives of those it serves by delivering high quality health care and services to eligible individuals at a maximum value to American taxpayers. As the administrators of the program, states, along with their local healthcare professionals who care for their neighbors, know best the unique healthcare needs of their community. Our success on delivering on Medicaid’s promise hinges on the critical role they play in managing the precious state and federal resources with which we are entrusted.

That’s why we have committed to resetting the state-federal partnership by ushering in a new era of state flexibility. We’ve approved groundbreaking Medicaid demonstration projections, including reforms to test how Medicaid can be designed to improve health outcomes and lift individuals from poverty by connecting coverage to community engagement. We are streamlining our internal processes and breaking down regulatory barriers that force states to commit too much of their time and resources to administrative tasks rather than focusing on delivering better care.

But with that commitment to flexibility must come an equal pledge to improve transparency and accountability. Too often we have struggled to articulate our collective performance in executing on our immense responsibility. This is best reflected in the fact that Medicaid is responsible for approximately half of the nation’s births, yet no one will argue that we are achieving the birth outcomes our future generations deserve. As we return power to states, we must shift our oversight role at CMS to one that focuses less on process and more on holding us all collectively accountable for achieving positive outcomes.

That is precisely why, last November, I announced that we would create the first ever CMS Medicaid and CHIP Scorecard to increase public transparency about the programs’ administration and outcomes. The data offered within the Scorecard begins to offer taxpayers insights into how their dollars are being spent and the impact those dollars have on health outcomes.  The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. As states continue to seek greater flexibility from CMS, the Scorecard will serve as an important tool in ensuring that CMS is able to report on critical outcome metrics.

The first version of the Scorecard is foundational to CMS’s ongoing efforts to enhance Medicaid and CHIP transparency and accountability. We’ve begun this initiative by publishing selected health and program indicators that include measures from the CMS Medicaid and CHIP Child and Adult Core Sets along with federal and state accountability measures. For the first time, we are publicly publishing measures that show how we are doing in the business of running these immense programs, including things like how quickly we review state managed care rate submissions or approve state section 1115 Medicaid demonstration projects. Our stakeholders, including beneficiaries, providers, and advocates, deserve to have this information available to them.

And we’re just getting started. Public reporting of meaningful quality and performance metrics is an important and ongoing responsibility of states and the federal government given Medicaid’s vital role in covering nation’s children and as the single greatest payer for long-term care services for the elderly and people with disabilities.

That’s why, in future years, the Scorecard will be updated annually with new functionality and new metrics as data availability improves, including measures that focus on program integrity as well as opioid and home and community-based services quality metrics. Over time, we plan to add the ability for users of the Scorecard to generate year-to-year comparisons on key metrics, as well as to compare states on measures of cost and program integrity. While some variation may be inherent based on geographic, population, reporting or programmatic differences, the public should have access to information that allows them to understand how and why costs and outcomes can vary from state to state for the same populations. Then we can begin to ask important questions about what may really be driving differences in quality and efficiency.

CMS recognizes that continued insight from our state partners is a critical component in the maintenance of the Scorecard. I want to thank all the states for their assistance in the creation of this first iteration, particularly the 14 states that served on the National Association of Medicaid Director’s workgroup over the last six months. Many of the measures are only possible because of the commitment from states to collect and report on these important metrics.  Through this partnership with states, CMS will continue to advance policies and projects that increase flexibility, improve accountability and enhance program integrity and are designed to fulfill Medicaid’s promise to help Americans lead healthier, more fulfilling lives.

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Quality Payment Program Exceeds Year 1 Participation Goal - CMS Blog

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services

Quality Payment Program Exceeds Year 1 Participation Goal 

I’m pleased to announce that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP) – exceeding our goal of 90 percent participation. Remarkably, the submission rates for Accountable Care Organizations and clinicians in rural practices were at 98 percent and 94 percent, respectively. What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high quality care and improved outcomes for patients.

Meeting the Challenges Ahead

Even with this high rate of participation, we are committed to removing more of the regulatory burdens that get in the way of doctors and other clinicians spending time with their patients. After only eight months, we’ve made significant progress through our Patients over Paperwork initiative: streamlining our regulations, increasing efficiencies, and improving care for patients. At the same time, we continue to put patients first by protecting the safety of our beneficiaries and strengthening the quality of healthcare they receive.

For example, we reviewed many of the MIPS requirements and developed policies for 2018 that continue to reduce burden, add flexibility, and help clinicians spend less time on unnecessary requirements and more time with patients.

In particular we have:

• Reduced the number of clinicians that are required to participate giving them more time with their patients, not computers.
• Added new bonus points for clinicians who are in small practices, treat complex patients, or use 2015 Edition Certified Electronic Health Record Technology (CEHRT) exclusively as a means of promoting the interoperability of health information.
• Increased the opportunity for clinicians to earn a positive payment adjustment.
• Continued offering free technical assistance to clinicians in the program.

Under the Bipartisan Budget Act of 2018 we have additional authority to continue our gradual implementation of certain requirements for three more years to further reduce burden in areas of MIPS.

We’re also eager to improve the clinician and patient experience through our Meaningful Measures initiative so that clinicians can spend more time providing care to their patients and improving the quality of care their patients receive. Within MIPS, we are adopting measures that improve patient outcomes and promote high-quality care, instead of focusing on processes.

Working with the Healthcare Community

We want to express our gratitude to all of the clinicians who collaborated with us as part of the voluntary Clinician Champions Program and the Clinician Voices initiative. We also want to thank all of you who participated in our various listening sessions and user groups throughout the year. Your input and feedback opened a dialogue, highlighted opportunities for improvement, and helped us identify ways to continue to reduce burden within the Quality Payment Program.

We deeply appreciate the contributions professional associations, consumer advocates and other important stakeholders have made to help engage their members and prepare them for success. We also want to acknowledge the networks supporting the free technical assistance available to clinicians, specifically the Small, Underserved, and Rural Support initiative, Quality Innovation Networks, and the Transforming Clinical Practice Initiative, who worked tirelessly to help clinicians familiarize themselves with the program so they can successfully participate. Together with our stakeholders and technical assistance networks, we hosted over 6,000 Quality Payment Program events last year. We used these events to describe requirements, offer tips, listen to you, and act on your feedback.

And, we’re proud to announce that our free technical assistance received a 99.8 percent customer satisfaction rating by over 200,000 clinicians and practice managers. The technical assistance networks also responded to 98.7 percent of initial referrals for additional support from the Quality Payment Program Service Center and Centers for Medicare & Medicaid Services (CMS) Regional Offices within 1-business day. We believe that there is an obligation to respond quickly, so clinicians can spend less time trying to figure out the program and more time with their patients.

Additionally, our Quality Payment Program Service Center complemented the technical assistance effort by fielding more than 130,000 inquiries and delivering world class customer support.

Better yet, all of the free and customized support from the technical assistance networks and the Quality Payment Program is still available to clinicians in the 2018 performance year!

Moving Forward Together

While we’re proud of what has been accomplished, there is more work to be done. CMS remains committed to listening to the healthcare community and exploring ways to reduce clinician burden, strengthen quality, introduce new payment models, develop meaningful measures including for patient safety, and promote interoperability. We look forward to continuing to hearing from you to make sure that we focus on patients, not paperwork.

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CMS Encourages Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention Program Model - CMS Blog

By CMS Administrator Seema Verma

Nationally expanded performance-based payment model now enrolling service suppliers

The Centers for Medicare & Medicaid Services (CMS) in April expanded the Medicare Diabetes Prevention Program (MDPP), a national performance-based payment model offering a new approach to type 2 diabetes prevention in eligible Medicare beneficiaries with an indication of pre-diabetes. For the first time, both traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. This innovative model promotes patient-centered care and continues to test market-driven reforms to drive quality of care and improve outcomes for America’s seniors, more than a quarter of whom have type 2 diabetes.

CMS recognizes that prevention is a critical part of creating an affordable healthcare system that puts patients first, and we encourage eligible suppliers to partner with us on this shared goal by participating in the national expansion of the MDPP.

As the CMS Innovation Center’s first preventive services model test to expand nationally, the MDPP is a key example of how we’re putting innovation to work. The model launched in 2012 as a small, voluntary model test at 17 sites across the country in partnership with the YMCA-USA, Centers for Disease Control and Prevention (CDC), and other public and private partners. Now, CMS is expanding this set of services nationwide based on promising results. In the initial model test, 45 percent of beneficiaries met the 5 percent weight loss target, which translates to a clinically meaningful reduction in the risk of developing type 2 diabetes.

Through the MDPP, trained community health workers and other health professionals empower beneficiaries at high risk of developing type 2 diabetes to take ownership of their health through curriculum-driven coaching and proven behavior change strategies for weight control. As a new preventive service for qualifying Medicare beneficiaries, MDPP services are available without a referral or co-payment.

The MDPP is not only a good value for our beneficiaries. Investing in prevention through performance-based payments and market-based incentives, this promising model will save the Medicare program more than $180 million by keeping beneficiaries healthy and averting new cases of diabetes[i].

One of the critical innovations in the MDPP is its approach to care delivery: For the first time, community-based organizations can enroll in Medicare to provide evidence-based diabetes prevention services after achieving preliminary or full recognition through the CDC. These organizations can enroll in Medicare to become an MDPP Supplier today, and CMS will continue to accept supplier applications on a rolling basis. Eligible organizations can begin the screening and enrollment process to become an MDPP Supplier by using the Provider Enrollment Chain and Ownership System (PECOS) or submitting the paper CMS-20134 Form. For information on the steps to enrollment, please refer to the MDPP Enrollment Fact Sheet.

Diabetes exerts an unacceptable toll on our beneficiaries, their families, and the Medicare program, which spends more than $104 billion every year treating patients with this preventable disease. The Medicare Diabetes Prevention Program is leveraging innovation to bring valuable preventive services to our beneficiaries, and I urge eligible organizations across the country to enroll today in this exciting performance-based payment opportunity.

[i] Federal Register. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Final Rule. November 15, 2017. [pg. 53355 – 53356] https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf

 

 

 

 

 

 

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Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program - CMS Blog

CMS Blog

https://blog.cms.gov/2018/03/02/medicare-access-and-chip-reauthorization-act-of-2015-macra-funding-opportunity

March 2, 2018
By Kate Goodrich, MD
Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer

 

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity:Measure Development for the Quality Payment Program

CMS is pleased to announce a new funding opportunity for the development, improvement, updating, and expansion of quality measures for use in the Quality Payment Program. CMS will be partnering directly with clinicians, patients, and other stakeholders to provide up to $30 million of funding and technical assistance in development of quality measures over three years.

Cooperative agreements provide a unique opportunity for CMS to partner with external entities, such as clinical specialty societies, clinical professional organizations, patient advocacy organizations, educational institutions, independent research organizations, and health systems, in developing, improving, updating, and expanding quality measures for the Quality Payment Program. By giving external entities needed resources to help guide their measure-development efforts though this funding opportunity, CMS can leverage the unique perspectives and expertise of these external entities, such as clinician and patient perspectives, to advance the Quality Payment Program measure portfolio. The cooperative agreements will allow CMS to collaborate with stakeholders to address essential topics such as: clinician engagement, burden minimization, consumer-informed decisions, critical measure gaps, quality measure alignment, consumer-informed decisions, clinician engagement, and efficient data collection that minimizes health care provider burden.

The priority measures developed, improved, updated or expanded under the cooperative agreements will be aligned with the CMS Quality Measure Development Plan. The CMS Quality Measure Development Plan provides a strategy for filling clinician and specialty area measure gaps and for recommendations to close these gaps in order to support the Quality Payment Program, and identifies the following initial priority areas for measure development: Clinical Care, Safety, Care Coordination, Patient and Caregiver Experience, Population Health and Prevention, and Affordable Care. The gap areas include, but not limited to: Orthopedic Surgery, Pathology, Radiology, Mental Health and substance use conditions, Oncology, Palliative Care, and Emergency Medicine.

More broadly than the CMS Quality Measure Development Plan, which is specific for the Quality Payment Program, CMS measures work is guided by the Meaningful Measurement framework which identifies the highest priorities for quality measurement and improvement. The Meaningful Measure Areas serve as the connectors between CMS goals under development and individual measures/initiatives that demonstrate how high quality outcomes for our Medicare, Medicaid, and CHIP beneficiaries are being achieved. They are concrete quality topics which reflect core issues that are most vital to high quality care and better patient outcomes.

Through these cooperative agreements, CMS aims to provide the necessary support to help external entities expand the Quality Payment Program quality measure portfolio with a focus on clinical and patient perspectives and minimizing burden for clinicians. Focusing on patient perspectives will ensure measures focus on what is important to patients and drive the improvement of patient outcomes. To accomplish this, the cooperative agreements prioritize the development of: outcome measures, including patient reported outcome and functional status measures; patient experience measures; care coordination measures; and measures of appropriate use of services, including measures of overuse.

For more information, search for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program on Grants.gov or visit our website, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html.

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CMS releases its Measures Under Consideration List for 2018 pre-rulemaking - CMS Blog

By: Kate Goodrich, M.D., M.H.S., Director, Center for Clinical Standards & Quality, CMS Chief Medical Officer

Medicare and other payers are rapidly moving toward a healthcare system that rewards high quality care while spending more wisely. Foundational to the success of these efforts is having quality measures that are meaningful to patients, consumers, and providers alike.  CMS recently announced the “Meaningful Measures” initiative to identify the most impactful areas for quality measurement and improvement and reflect core issues that are most vital to high quality care and better individual outcomes. Each year, CMS publishes a list of quality and cost measures that are under consideration for Medicare quality reporting and value-based purchasing programs, and collaborates with the National Quality Forum (NQF) to get critical input from multiple stakeholders, including patients, families, caregivers, clinicians, commercial payers and purchasers, on the measures that are best suited for these programs. Ultimately, these measures may help patients choose the nursing home, hospital, or clinician that is best for them, and can help providers to provide the highest quality of care across care settings.

I am happy to announce that CMS posted the Measures under Consideration (MUC) List for 2018 pre-rulemaking on the CMS website and has sent it to NQF in preparation for multi-stakeholder input.

This year’s MUC List contains 32 measures that have the potential to drive improvement in quality across numerous settings of care, including clinician practices, hospitals, and dialysis facilities. CMS is considering new measures to help quantify healthcare outcomes and track the effectiveness, safety and patient-centeredness of the care provided.  At the same time, CMS is taking a new approach to coordinated implementation of meaningful quality measures focused on the most critical, highly impactful areas for improvement while reducing the burden of quality reporting on all providers so they can spend more time with their patients.  In addition to other factors, CMS evaluated the measures on the MUC list to ensure that measures considered for adoption in a CMS program through rulemaking as necessary, focus on clearly defined, meaningful measure priority areas that safeguard public health and improve patient outcomes.  For example, to generate this year’s MUC list, CMS considered 184 measures submitted by stakeholders during an open call for measures.  Considering the meaningful measurement areas, CMS narrowed the list to 32 measures (17% of the original submissions) which focus CMS efforts to achieve goals of high quality healthcare and meaningful outcomes for patients, while minimizing burden. CMS will continue to use the Meaningful Measures approach to strategically assess the development and implementation of quality measure sets that are the most parsimonious and least burdensome, that are well understood by external stakeholders, and are most likely to drive improvement in health outcomes.

This year, approximately 40% of measures on the MUC list are outcome measures, including patient-reported outcome measures, which will help empower patients to make decisions about their own healthcare and help clinicians to make continuous improvements in the care provided. In addition, this year there are eight episode-based cost measures proposed that were developed by incorporating the insight and expertise of clinicians and specialty societies.  CMS is committed to working with clinicians, consumers, and other stakeholders on the development and use of measures that are most meaningful to patients and clinicians and our programs.

We invite you to review the MUC List in detail and to participate in the public process. We believe it is critical to hear a wide range of voices in the selection of quality and efficiency measures that are used for accountability and transparency purposes and look forward to another successful pre-rulemaking season. For more information regarding the NQF Measure Applications Partnership public stakeholder review meeting purpose, meetings, 2017 MUC List deliberations and voting, visit the NQF website at http://ift.tt/IXUWWv.

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CMS announces a new user-centered resource to help improve alignment: the CMS Measures Inventory Tool (CMIT) - CMS Blog

By Kate Goodrich, MD
Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer

CMS is actively working to move the needle on improving quality in healthcare without additional burden to those providers on the frontlines. CMS recently launched a new initiative, ‘Meaningful Measures,’ which will streamline current measure sets – so providers can focus on the measures that are most impactful – and will move from process measures to outcome measures where possible. A great deal of attention has also been focused on alignment of quality measures within CMS and with commercial payers, and we are committed to working towards alignment of these measures to ensure delivery of high quality care to all Americans while minimizing burden on providers.

I am pleased to announce that CMS is deploying an innovative tool that provides all stakeholders improved visibility into the portfolio of CMS measures. The CMS Measures Inventory Tool (CMIT), an interactive web-based application that contains the same information that is currently included on the  Excel spreadsheet, provides a comprehensive list of measures that are currently under development, implemented for use, and have been removed from a CMS quality program or initiative.  The intuitive and user-friendly functions allow you to find measures quickly and to compile and refine sets of related measures. The tool increases transparency and can be used to identify measures across the continuum of care and will help coordinate measurement efforts across all conditions, settings, and populations.  We have expanded the information contained in the inventory to better answer questions we have heard from the public; the CMIT lists each measure by program, dates of measure consideration and implementation, and measure specifications including, but not limited to, numerator, denominator, exclusion criteria, measure type, and National Quality Forum (NQF) endorsement status.

CMIT is an innovative approach that will help to promote the goal of increased alignment across programs and with other payers.  We believe it is an easy to use valuable resource to various stakeholders, including commercial payers, clinicians, patients and measure developers.

For more information about CMIT and to access the tool, please visit the CMS.gov website.

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Administrator’s Blog: National Rural Health Day (November 16, 2017) - CMS Blog

November 16, 2017

By: Seema Verma, CMS Administrator @SeemaCMS 

Today, CMS is celebrating National Rural Health Day by commemorating our partners who provide quality care to the nearly one in five Americans who reside in rural communities. CMS recognizes the unique challenges facing rural America, and we are taking action to improve access and quality for healthcare providers serving rural patients.

This fall, I have been visiting communities throughout the country to learn more about issues critical to improving access to rural healthcare. I travelled to Kansas City and visited the headquarters of the National Rural Health Association to talk with key leadership and stakeholders to hear how CMS can reduce the challenges rural communities face. CMS is committed to evaluating our policies and looking at each of them through a rural lens to ensure rural providers greater flexibility and less regulatory burden.

New technologies are emerging that have strong promise to address access issues in rural communities. CMS is trying to modernize the Medicare program so that beneficiaries can make use of the new technology. For example, CMS recently released new telehealth payment codes in Medicare so more services can be accessed in rural areas. This is only the beginning of our overall strategy to update our programs and improve access to high quality services.

Rural hospitals also face challenges in recruiting physicians. CMS is addressing this challenge by placing a two-year moratorium on the direct supervision requirement for outpatient therapeutic services at Critical Access Hospitals and small rural hospitals. This policy helps to ensure access to outpatient therapeutic services for Medicare beneficiaries living in rural communities and provides regulatory relief to America’s small rural hospitals. In Medicare Advantage plans, we are working to ensure network standards offer the flexibility needed to provide greater health care plan choices to rural beneficiaries. These reforms are in line with our focus on improving the beneficiary experience.

In response to feedback received from Critical Access Hospitals and other rural stakeholders, CMS recently announced that Critical Access Hospitals should no longer expect to receive medical record reviews related to the 96-hour certification requirement absent concerns of probable fraud, waste, or abuse. 

We are also now providing technical assistance and greater flexibilities to small and rural clinicians to help facilitate their participation in the Quality Payment Program (QPP). These efforts are aligned with our goal of reducing regulatory burden so clinicians are able to spend more time on patient care and healthier outcomes, and less time on paperwork. One way we have done this is to provide free and customized technical assistance to support small and rural clinicians every step of the way, as well as assistance through our Service Center, Regional Offices, and the QPP page on cms.gov.

We have finalized several policies to reduce burdens and help clinicians in small practices successfully participate in the QPP program. Some of these include:

• Increasing the “low volume threshold,” which is the maximum amount of Medicare revenue and the maximum number of Medicare patients that a clinician can have while being excluded from the new requirements, to exclude more small practices from QPP.
• Adding an option for clinicians to come together in “virtual groups” to report data together and share the burden of meeting the new requirements.
• Continuing to award small practices a minimum of three points for quality measures, recognizing that small practices may not be able to pull together the amount of data as easily as large practices.
• Providing small practices with a new hardship exception to some of the EHR reporting requirements.
• Adding five bonus points to the final performance score for small practices.

In our effort to consider a new direction that promotes patient-centered care and test market-driven reforms, the CMS Innovation Center is currently seeking suggestions on improving rural healthcare by way of a recently released Request for Information (RFI). The opportunity to provide recommendations for the new direction closes November 20 and if you have not already, we hope you will share your thoughts.

CMS has also developed a number of resources to help rural providers and other stakeholders.  To improve the customer experience and further empower our rural providers, we are centralizing rural healthcare resources into a single website which you can find here.

And finally, CMS does not operate in a vacuum.  We work closely with other federal partners including the Health Resources and Services Administration, the Office of the National Coordinator, and the Centers for Disease Control and Prevention, among others, to ensure our efforts to improve care in rural America are consistent with those agencies’ rural initiatives. CMS will continue to listen to, work with, and value the input from rural stakeholders.  Together, we can improve care in rural America.  Happy National Rural Health Day!

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CMS’s 2017 Medicare Fee-For-Service improper payment rate is below 10 percent for the first time since 2013 - CMS Blog

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November 15, 2017
By Kimberly Brandt, Principal Deputy Administrator for Operations (@cms.hhs.gov)

The Centers for Medicare & Medicaid Services (CMS) is committed to reducing improper payments in all of its programs, as evidenced by improper payment reduction efforts contained in the Fiscal Year 2018 President’s Budget. CMS’s new leadership is re-examining existing corrective actions and exploring new and innovative approaches to reducing improper payments, while minimizing burden for its partners. Due to the successes of actions we’ve put into place to reduce improper payments, the Medicare Fee-For-Service (FFS) improper payment rate decreased from 11.0 percent in 2016 to 9.5 percent in 2017, representing a $4.9 billion decrease in estimated improper payments. The 2017 Medicare FFS estimated improper payment rate represents claims incorrectly paid between July 1, 2015 and June 30, 2016. This is the first time since 2013 that the Medicare FFS improper payment rate is below the 10 percent threshold for compliance established in the Improper Payments Elimination and Recovery Act of 2010.

Improper payments are not always indicative of fraud, nor do they necessarily represent expenses that should not have occurred.  For example, instances where there is insufficient or no documentation to support the payment as proper are cited as improper payments under current Office of Management and Budget guidance.  The majority of Medicare FFS improper payments are due to documentation errors where CMS could not determine whether the billed items or services were actually provided, were billed at the appropriate level, and/or were medically necessary. A smaller proportion of Medicare FFS improper payments are payments for claims CMS determined should not have been made or should have been made in a different amount, representing a known monetary loss to the program.

Figure 1 provides information on Medicare FFS improper payments that are a known “monetary loss” to the program (i.e. medical necessity, incorrect coding, and other errors). The estimated known “monetary loss” improper payment rate is 3.0 percent, representing an estimated known monetary loss of $11.3 billion out of the total estimated improper payments of $36.2 billion.  In the figure, “unknown” represents payments where there was no or insufficient documentation to support the payment as proper or a known monetary loss. In other words, when payments lack the appropriate supporting documentation, their validity cannot be determined.  These are payments where more documentation is needed to determine if the claims were payable or if they should be considered monetary losses to the program.

Figure 1: FY 2017 Medicare FFS Improper Payments (in Millions) and Percentage of Improper Payments by Monetary Loss and Type of Error

 

CMS continues to implement tools and work with law enforcement partners and other key stakeholders to help focus on prevention, early detection, and data sharing to prevent and reduce improper payments in Medicare FFS.  Although documentation errors are the largest cause of improper payments, CMS employs multi-layered efforts to target all root causes of improper payments, with an emphasis on prevention-oriented activities.

CMS is pleased to have achieved this reduction in the improper payment rate, but we still have work to do.  We remain committed to collaborating across CMS and with stakeholders to address potential vulnerabilities and continuing to strengthen our program integrity efforts, while minimizing burden for our partners.

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Thank You For Your Service - CMS Blog

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November 9, 2017
By:  Seema Verma, CMS Administrator

Thank You for Your Service

We’ve all heard the stories of bravery and sacrifice, or have personally experienced the inspiring dedication to service of our US Military veterans, but for me their heroism was made real on a visit to Normandy.

Early in the morning on D-Day, June 6, 1944, Army Rangers climbed the cliffs of Point-du-Hoc to the west of Omaha Beach to destroy a battery of 155mm German cannons on top of the cliff. As I stood there, viewing these cliffs as a tourist, I couldn’t help but imagine the fear that must’ve been going through their minds as they scaled those massive, rocky cliffs under heavy German fire, only to reach the top and face even heavier opposition. How, in the face of what they must have considered certain death, they pressed on knowing the importance of their mission, and that their actions would save countless American and foreign lives.

I then went to see the cemetery where those lost on D-Day, including the Army Rangers who died while taking that hill, were buried. While looking at that field of graves, I found myself emotionally overwhelmed thinking about how these men died for the freedom and safety of people they didn’t know and would never meet.

As a public servant, on this day and every day, I think about the sacrifices of America’s Veterans, both dead and living, that inspire me to also make sacrifices so that others can live better lives. When I think about the work we do at CMS, I think about those Rangers, I think about the price they paid for our freedoms, and I think about the fact that their sacrifice should be honored by making sure that we serve our country in a manner worthy of their heroism.

America’s veterans are heroes. CMS currently employs 591 veterans, comprising 10% of our workforce. Last year we hired 38 veterans, and will continue to recruit and retain veterans within our ranks because they not only bring a wealth of knowledge and skill, but a profound sense of honor and dedication to public service that is an important quality in all CMS employees.

To America’s veterans, thank you for your service, and your devotion to our country. We at CMS will never take for granted what you have done for us and for this country. On behalf of myself, my family, and CMS employees currently serving all across our country, I hope you have a great Veterans Day, you’ve earned it.

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Medicare Open Enrollment – New Features make Shopping for 2018 Coverage Easier! - CMS Blog

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services (CMS)

Each October, as the days grow shorter, time seems to speed up. Maybe it’s because we start planning for the looming holidays or begin bracing for the cold winter, but before we know it we’re saying goodbye to one year and ringing in a new one. That’s why it’s important to set aside some time between now and early December to think about your 2018 healthcare needs by shopping for high-quality Medicare health and drug plans during Open Enrollment.

Medicare Open Enrollment kicked off on October 15 and will run through December 7. I’m pleased to share that you will have better access to high-quality health coverage choices offering more options and lower premiums in 2018. This means you should be able to find plans that cost less but still give you quality care and better customer service. In fact, the number of Medicare Advantage plans available to individuals across the country is increasing from about 2,700 to more than 3,100 – and more than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans. We are estimating that the average Medicare Advantage monthly premium will decrease by $1.91 in 2018, from an average of $31.91 in 2017 to $30. The Medicare prescription drug plan average basic premium is projected to decline for the first time since 2012 (a decrease of approximately $1.20 below the 2017 average basic premium of $34.70).

The choices available demonstrate the benefits of supply and demand market forces in a strong healthcare market. Consumers are demanding more from their insurance plans and in turn Medicare Advantage and Part D plans, like any business, are responding with better service at a lower cost leading to a truly patient-centered approach to healthcare.

Medicare is making some exciting changes of our own to make it easier for you to make an informed choice between Original Medicare and Medicare Advantage. You may have noticed a few of these changes in your Medicare & You handbook, but it doesn’t stop there. We’re improving our digital features on Medicare.gov, where you can sign-up to get timely notices about Open Enrollment and other important Medicare updates directly to your inbox. While on Medicare.gov be sure to check out the new help wizard that will point you to resources that will help you make informed healthcare decisions. These updates mirror the private sector and reflect a few ways we’re modernizing the customer service experience.

If you’ve been thinking about starting your new year with a Medicare Advantage or Prescription Drug Plan, or you’re interested in making some changes to your current plan, now is the time to shop for your coverage. Medicare health and drug plans change each year, and so can your health needs. That’s why it’s always a good idea to consider what needs you may have for 2018 and take a look at the available plans in your area.

Your coverage will begin on January 1, 2018. If you miss the deadline, you will likely have to wait a full year before you are able to make changes to your plan. During Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you find your current coverage still meets your healthcare needs, then you’re done.

Open Enrollment is also a good opportunity to make sure you’re doing everything you can to protect your identity and your health by guarding your Medicare card like you would a credit card. Identity theft resulting from stolen Medicare numbers is becoming more and more common. Medicare is here to help in the fight by removing Social Security Numbers from Medicare cards and replacing them with a new, unique number for each person with Medicare. Medicare will mail new Medicare cards with the new numbers between April 2018 and April 2019.

Don’t let the opportunity to have better quality healthcare at a lower price pass you by. Get a jump start on your new year’s health resolution today. You can visit Medicare.gov (http://www.medicare.gov), call 1-800-MEDICARE, or contact your State Health Insurance Assistance Program (SHIP) to learn more.

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Las Nuevas Tarjetas de Medicare Ya Llegarán Pronto - CMS Blog

Por: Seema Verma, Administradora de los CMS

Como podría haber escuchado ya, o quizás ya vio un comercial de televisión, los Centros de Servicios de Medicare y Medicaid pronto emitirán a cada beneficiario de Medicare una nueva Tarjeta de Medicare, sin números de Seguro Social, para prevenir el fraude, mantener seguros los fondos de los contribuyentes, y para asegurar que siempre ponemos las necesidades de los pacientes primero.

Desafortunadamente los criminales están cada vez más interesados en las personas de 65 años o más para el robo de identidad médica, incluso cuando alguien usa ilegalmente el número de Medicare de otra persona. Un ladrón de identidad puede facturarle a Medicare por servicios costosos que nunca fueron proporcionados o cobrar más por los servicios proporcionados. Esto puede resultar en ambigüedades en los registros médicos, lo que puede significar el retraso en la atención o servicios negados para los pacientes y también impacta los fondos de los contribuyentes.

Para ayudar a combatir esto, les enviaremos a todos los beneficiarios de Medicare una nueva tarjeta con un número único asignado al azar. Cuenta con once caracteres, una combinación de números y letras mayúsculas.

Debido a que el número se genera al azar, no hay conexión a otra información de identificación personal. Este nuevo número reemplazará al número actual basado en el Seguro Social, y está diseñado para proteger la información personal de los beneficiarios de Medicare.

Comenzaremos a enviar por correo las recién diseñadas tarjetas de Medicare en abril de 2018, y reemplazaremos todas las tarjetas antes de abril de 2019. Si usted es beneficiario de Medicare o pronto lo será, no tendrá que hacer nada y podrá comenzar a usar su nueva tarjeta tan pronto como la reciba.

Cuando reciba su nueva tarjeta, le pediremos que destruya su tarjeta de Medicare de una manera segura. Asegúrese de traer la nueva tarjeta a las citas de sus médicos, y mantenga siempre confidencial su nuevo número. Esto ayudará a proteger su identidad personal y prevenir el fraude de identidad médica porque los ladrones de identidad no pueden facturar a Medicare sin un número de Medicare válido. Además, usted y sus proveedores de atención médica podrán utilizar herramientas seguras en línea que estamos desarrollando y que brindarán acceso rápido a su número de Medicare cuando sea necesario.

Usted va a escuchar mucho más acerca de esta iniciativa en las próximas semanas y meses, y también estamos ayudando a los médicos y otros proveedores de atención médica a prepararse para el cambio. Queremos hacer este proceso tan fácil como sea posible para todos los involucrados. Sobre todo, queremos que las personas con Medicare y los proveedores de atención médica sepan estos cambios con anticipación y tengan la información necesaria para asegurar una transición fácil a la nueva tarjeta.

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New Medicare Cards are Coming Soon - CMS Blog

By:  Seema Verma, CMS Administrator

As you may have heard, or perhaps you’ve seen a recent TV commercial, the Centers for Medicare & Medicaid Services will soon be issuing every Medicare beneficiary a new Medicare Card, without Social Security Numbers, to prevent fraud, fight identity theft, and keep taxpayer dollars safe, and to help ensure that we always put the needs of patients first.

It’s unfortunate that criminals are increasingly targeting people age 65 or older for medical identity theft, including when someone illegally uses another person’s Medicare number. An identity thief may bill Medicare for expensive services that were never provided or overbill for provided services. This can lead to inaccuracies in medical records, which can mean delayed care or denied services for patients and impacts taxpayer funding.

To help combat this, we’ll be sending all Medicare beneficiaries a new card with a unique, randomly-assigned Medicare number.  It will consist of eleven characters, a combination of numbers and uppercase letters.

Because it is randomly generated, there is no connection to any other personal identifying information. This new number will replace the Social Security-based number currently used on all Medicare cards, and it’s designed to protect the personal information of Medicare beneficiaries.

We’ll begin mailing the newly designed Medicare cards in April 2018, and we’ll replace all cards by April 2019. If you’re a Medicare beneficiary, or soon will be, you don’t need to do anything, and you can start using your new card as soon as you get it.

When you get your new card, we’ll ask you to safely and securely destroy your current Medicare card.  Make sure you bring the new card to your doctors’ appointments, and always keep your new number confidential.  This will help protect your personal identity and prevent medical identity fraud because identity thieves can’t bill Medicare without a valid Medicare number. Additionally, you and your health care providers will be able to use secure online tools that we’re developing that will support quick access to your Medicare number when needed.

You’ll be hearing a lot more about this initiative in the coming weeks and months, and we’re also helping doctors and other healthcare providers get ready for the change.  We want to make this process as easy as possible for everyone involved. Above all, we want to ensure that people with Medicare and healthcare providers know about these changes well in advance and have the information needed to ensure an easy transition to the new card.

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The true strength of our healthcare system is its people - CMS Blog

By Seema Verma, Administrator for the Centers for Medicare & Medicaid Services

As a wife and mother, my family’s health is always foremost on my mind. That is why a recent personal experience will forever shape the impact I want to have while serving as Administrator of the Centers for Medicare and Medicaid Services.

Earlier this month, while at an airport with our two children, my husband collapsed and went into cardiac arrest. He’s home now and his prognosis is excellent. However, if it weren’t for the courageous bystanders who administered CPR and the dedicated medical professionals at the Hospital of the University of Pennsylvania where he was admitted, he wouldn’t be with us today.

I wasn’t at the airport when my husband collapsed. I arrived at the hospital as soon as I could, and as I met the team of professionals who were caring for him, I was amazed by their skill and compassion. From the hospital administrators to the physicians, nurses, and many others who took charge of his care, I witnessed the true greatness of our healthcare system: the remarkable people who serve within it.

My life would be very different if it weren’t for the diligence and expertise of the first responders at the airport and the healthcare professionals at the hospital. Even in our age of advanced technology, procedures, and therapies, it’s the people that make our healthcare system one that we feel we can entrust with the care of our loved ones.

My husband is a physician, and I have many relatives and close friends who are healthcare professionals as well.  To a person these caregivers are some of the smartest and most selfless people I know. They have put in long hours and made many sacrifices along the path of medical education and training. What motivates them isn’t a promise of high salaries, or a quest for esteem, but a genuine drive to help patients and their families when they are most vulnerable.

Our healthcare system is made up of a community of professionals who want to do good.  As a wife and a mother I am so grateful for this, because these professionals saved my husband and my children’s father. As the Administrator of CMS, I am inspired by this and feel compelled to do everything I can to support these caregivers. Our agency must make it easier for them to focus on doing the work that patients and families need them to do without causing them to be subject to excessive regulatory and administrative burden.

That’s why in all of our recent proposed rules, CMS has asked healthcare providers for their thoughts on how to simplify our regulations. And over the next few months we will be announcing additional initiatives to ease the burden our government places on healthcare providers. We will continue to engage with our providers on their concerns.

Some regulations are necessary in order to ensure patient safety and well-being, and to protect the integrity of federal health care programs.  However, over the past few years, regulations have tilted more towards creating burdens than towards serving as a safeguard for the programs.  This shift is now having a negative impact on patient care, hindering innovation, and increasing healthcare costs.

To make sure we are addressing the actual pain points that doctors feel, we are visiting them where they work, listening to their stories about the challenges they face, and bringing those lessons back to CMS. We have heard time and again that documentation for payment and for quality reporting is unnecessarily time-consuming and keeps clinicians working late into the night just to keep up on paperwork. Electronic health records that were supposed to make providers’ lives easier by freeing up more time to spend on patient care have distanced them from their patients. New payment structures that were meant to increase coordination have added yet another layer of rules and requirements.

No one went into medicine to become a paperwork expert. We are listening, integrating the feedback we hear into our work at CMS, and making changes that will make it easier for doctors, nurses, and other clinicians to do what they entered medicine to do: take care of those in need.

It can be easy to forget how important our healthcare system is, to forget that every day, men and women are hard at work treating, comforting, and healing. For those of us whose families have received lifesaving care, we are forever grateful. The entire CMS team and I are committed to doing our part to make sure that these caring professionals can do their job without the burden of unnecessary regulation.

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National Minority Health Month: Bridging Observance and Action to Achieve Health Equity - CMS Blog

By Cara V. James, PhD, Director, CMS Office of Minority Health 

Each April we observe National Minority Health Month. This year’s theme is, Bridging Health Equity Across Communities. This theme acknowledges the important role that social determinants of health play in individual and community well-being. It also evokes action and activity  around health equity. For it is not enough for us to simply observe National Minority Health Month and share statistics on long-standing health and health care disparities. We should strive to move the needle by reducing these disparities and improving health care quality and outcomes for all. As this National Minority Health Month comes to a close, we still have work to do, and I’m hoping each of us can take a moment and consider the following question:

What will it take to achieve health equity?

CMS has adopted a health equity framework that focuses on increasing understanding and awareness of disparities, developing and disseminating solutions, and implementing sustainable action. As we have sought to implement this framework, we have identified a number of areas that need to be considered when addressing a specific disparity– the social determinants of health, data, and the seven “A’s”.
First and foremost, we need to acknowledge there is a problem to be addressed. We need to agree on the goal and identify what resources will be necessary to meet it. Resources can be difficult to come by, so determining how the goal aligns with existing priorities may be key. Next we must decide what actions do we need to take to achieve our goal? Are we already doing some or all of them?

Seven A’s for Addressing Health Equity

1. Acknowledge there is a problem to be addressed.
2. Agree on the goal, and identify what resources are necessary to meet it.
3. Align the goal with existing priorities.
4. Determine what actions are needed to achieve the goal.
5. Create alliances to implement the actions.
6. Analyze progress, and adjust the plan as necessary.
7. Have shared accountability for reaching the goal.

 

We know that health equity cannot be achieved by a single individual or organization, so forging alliances and working together is critical. We also know that we must be able to measure our progress. Having data and doing analysis of it are important for the development, assessment, and revision of our health equity plan. The last of the A’s requires us to be accountable and ask the question – what happens if we do not reach our goal? There shouldn’t be one person or organization responsible for the success or failure of a plan, but a shared accountability.

While we are considering each of the seven A’s, we must also consider the myriad of social factors that influence health and well-being of individuals and the communities in which they reside. Whether we refer to them as social risk factors or social determinants of health, we know that things such as socioeconomic position, race, ethnicity, cultural context, gender, social relationships, and residential and community context affect our health more than the care we receive from our health care providers. We must consider these factors as we think about our goals, the actions we need to take, and the alliances we forge.

The CMS Office of Minority Health is helping to embed these actions across CMS and HHS. For example, we routinely share HEDIS and CAHPS quality measures stratified by race, ethnicity, and gender, providing health plans with actionable data to innovate and prioritize health equity and quality improvement activities. Organizations participating in the Accountable Health Communities Model will be montoring disparities as they link beneficiaries with commmunity services. We are working with our sister agency, the Health Resources and Services Administration’s, Federal Office of Rural Health Policy on a Chronic Care Management Education and Outreach Campaign. The campaign is focused on professionals and consumers in underserved rural areas, and racial and ethnic minorities. We are also collaborating with organizations outside the federal government to help reduce readmissions among racially and ethnically diverse beneficiaries, and to develop their own plans for achieving health equity.

As we continue on our path to equity, we encourage you to consider the seven A’s, the role of social risk factors, and the importance of data in your day-to-day activities. Recommit every day to the ultimate goal of achieving health equity by bridging observance and action during the remainder of National Minority Health Month and throughout the year.

To learn more about achieving health equity and other activities underway at the CMS Office of Minority Health, visit: go.cms.gov/omh. 

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CMS’ Ongoing Commitment to Minority Health - CMS Blog

April 26, 2017

By: Seema Verma, Administrator, Centers for Medicare & Medicaid Services (CMS)

As many of you know, April is National Minority Health Month, and it’s a privilege to be Administrator at the Centers for Medicare & Medicaid Services (CMS) and take part in the observance. This year’s theme is “Bridging Health Equity Across Communities”. At CMS we have an extraordinary opportunity to improve health outcomes for the over 100 million people that we serve every day. Our primary mission is to make healthcare accessible and affordable for all Americans.

During this important month, we continue our efforts to raise awareness about disparities, and provide tools and resources to support actions to address them. In addition to our ongoing work to address these disparities through efforts like the CMS Equity Plan for Improving Quality in Medicare, the CMS Office of Minority Health released new Medicare Advantage (MA) data on racial and ethnic disparities in care. The data helps us understand the connections between a person’s race, ethnicity, and gender and the health care that they receive.

Two new reports focus on the treatment and patient care experiences for a variety of conditions. The first report looks at racial and ethnic disparities by gender and examines differences between black, Hispanic, Asian and Pacific Islander and white MA beneficiaries in rates of colorectal cancer screening, treatment for chronic lung disease and other conditions as well as their ability to access needed care.

The second report looks at racial and ethnic minorities, people with disabilities, members of the lesbian, gay, bisexual, and transgender community, and rural populations in quality of treatment for certain conditions among MA beneficiaries. It shows that women receive better treatment for chronic lung disease and rheumatoid arthritis and are more likely than men to receive proper follow-up care after being hospitalized for a mental health disorder.

This tremendous research can only point out the problems. We need healthcare professionals, stakeholder organizations, researchers, and community groups to use these CMS reports, along with our other tools and resources, to develop interventions for racially and ethnically diverse Medicare beneficiaries. 

Through transparency, flexibility, and innovation, we will use every available tool to improve the Medicare program and promote the availability of high value and efficiently-provided care for all beneficiaries. We do this, by working together with plans, providers and the patients we serve to find ways to reduce the disparities highlighted in these reports and find effective health solutions that work for all communities and all Americans.

 

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Supporting Comprehensive and Innovative Care for Children: Request for Information on a Potential Pediatric Alternative Payment Model - CMS Blog

February 27, 2017

By Patrick Conway, M.D., M.Sc., Acting Administrator, Centers for Medicare & Medicaid Services; Deidre Gifford, M.D., M.P.H., Deputy Director, Center for Medicaid and CHIP Services; Ellen-Marie Whelan, N.P., Ph.D., Chief Population Health Officer, Center for Medicaid and CHIP Services; and Alex Billioux, M.D., D.Phil., Director, Division of Population Health Incentives and Infrastructure, Center for Medicare & Medicaid Innovation

In partnership with states and providers, the Centers for Medicare & Medicaid Services (CMS) plays a leading role in safeguarding the health of America’s future by providing coverage for more than one in three American children[1]. Through Medicaid and the Children’s Health Insurance Program’s (CHIP) mandatory and optional benefits, children receive access to a spectrum of comprehensive and preventive health care services aimed at providing a sound start for lifelong health. As a result, children enrolled in Medicaid and CHIP lead the nation in participation in preventive care and access to needed care[2].

CMS and states have also demonstrated consistent commitment to improving the health of children through care redesign and innovation in programs such as Medicaid Health Homes, the Medicaid Innovation Accelerator Program, and models tested under the Center for Medicare and Medicaid Innovation (Innovation Center), including the State Innovation Models Initiative and Strong Start for Mothers and Newborns Initiative. To build on those efforts, the Innovation Center, in partnership with the Center for Medicaid and Chip Services (CMCS), is releasing a Request for Information (RFI) today seeking input on the design of alternative payment models focused on improving the health of children and youth covered by Medicaid and CHIP. As the insurer of a third of the nation’s children and a leader in health care innovation, CMS is uniquely positioned to improve the health of America’s children.

We know there is more to health than health care alone, and for children, factors such as sound nutrition, safe living environments, responsive adult caregivers, and nurturing social relationships are especially critical for healthy growth and development. Inadequate or inconsistent access to these factors can have physical and behavioral impacts that reverberate throughout a child’s life course as he or she grows into adulthood. Some children and youth enrolled in Medicaid and CHIP, especially those that are high-need and high-risk, may experience barriers to accessing the optimal combination of child-focused programs and services that are available to address these critical factors. Through the RFI, we are seeking input on approaches to improve the quality and reduce the cost of care for children and youth enrolled in Medicaid and CHIP. In particular, we are exploring concepts that encourage pediatric providers to collaborate with health-related social service providers (e.g., early childhood development programs, child welfare services, and home and community based service providers) at the state and local levels and share accountability for health outcomes for children and youth enrolled in Medicaid and CHIP.

CMS seeks input through the RFI from the broad community of child and youth-focused stakeholders on concepts critical to addressing the comprehensive health needs of children and youth, such as:

• Opportunities and impediments to extending and enhancing integrated service model concepts like accountable care organizations (ACOs) to the pediatric population;
• Flexibilities and supports states and providers may need in order to offer such models of care to a state’s pediatric population; and
• Approaches for states and providers to coordinate Medicaid and CHIP benefits and waivers with other health-related social services for children and youth.

Investing in child health can provide lifelong benefits and improve the nation’s health. We look forward to front-end comments from our state partners and other stakeholders who share our dedication to improving the health of our nation’s children.

For more information on the RFI, please visit: http://ift.tt/2mwn8Xw. To be assured consideration, RFI comments must be received by March 28, 2017.

[1] Department of Health and Human Services. 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP. February, 2016. http://ift.tt/2huLelF

[2] See CHIPRA Mandated Evaluation of the Children’s Health Insurance Program: Final Findings, available at

http://ift.tt/2mwnzkx; Kreider AR, French B, Aysola J, Saloner B, Noonan KG, Rubin DM. Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families. JAMA Pediatr. 2016;170(1):43-51. doi:10.1001/jamapediatrics.2015.3028

 

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Mark Your Calendars: January 31st is quickly approaching - CMS Blog

If you still need health coverage for 2017, you have until January 31^st to sign up for coverage through HealthCare.gov. Through the website you can review your choices and see if you qualify for financial help. Issuers have confirmed that consumers who select a plan and pay their first premium will have coverage for 2017. And, insurers have signed contracts to provide coverage through 2017.

Consumers who want coverage – whether you are new to the Health Insurance Marketplace or have previously enrolled in health coverage – can visit HealthCare.gov, update your information, or add it for the first time, and select a plan. You may also compare plans online or on your mobile device. You can review the core plan features like cost-sharing and provider networks.

When you log onto HealthCare.gov, you need three pieces of information – your zip code, family size, and household income – to see what plans are available to you and to get an estimate of how much the plans cost. If you had coverage through HealthCare.gov for 2016, you can come back to update your information and compare your options for 2017. If you have questions or want to talk through your options with a trained professional, enrollment specialists are available all day, every day, at 1-800-318-2596. Free, confidential, in-person assistance is also available at enrollment sites and events in your state. Visit localhelp.healthcare.gov to find assistance in your community.

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Remarks by Andy Slavitt to the CMS staff: A simple thank you - CMS Blog

Below are prepared remarks by Andy Slavitt, CMS Acting Administrator before a CMS All-Staff Meeting on January 17, 2017

Good afternoon and welcome.

I remember about 2 years ago coming here for the first time, sitting down with Aaron Albright at our first all-staff chat. My thoughts today come full circle to my goals and aspirations for CMS and for you — from where we started to where we are now. But, I want to start by talking about how CMS has affected me.

CMS has been my family these last 2 years. I’ve been away from home, living in an apartment, away from my wife and kids. We believed this would allow me to focus on work, without the distraction of home life during the week. What I didn’t see coming was how much CMS would also begin to feel like home. And it began almost instantly as everyone generously welcomed me in as if I had been here forever. I will never forget how you made me feel part of the team.

I recognized how much I had to prove in joining this family. You had all dedicated a great deal of your lives as public servants and I was just beginning. I promised myself that even though I could never match the decades so many of you have contributed here at CMS, my aim would be to try to have the impact of 20 years in the two I had ahead of me by figuring out where I could help the most and then giving it everything I had. I know I didn’t succeed in everything I tried to take on, but the team here at CMS was generous and patient. You welcomed me into your offices when I visited the regions. I asked what could be done to make your work here better and you told me what mattered to you. As I did this, I got to see the impact and vitality of the work up close. I was most impressed with stories of why you have chosen to be here.

You also listened to my opinions when we talked together about what we could become and what we could achieve:

Getting closer to our customers. Executing with passion. Working together in new ways across our silos.  Not being afraid to take on challenges and do our best work. Opening up and exposing ourselves transparently so we could get closer to the action. Closer to where Americans get their care. Listening to all the voices impacted by our work. Measuring ourselves not by our own standards, but by the standards of the outside world. Being self-critical instead of defensive.

You showed me we could do all of these things and I believe that one of the keys to our success has been and will be our culture. The country needs a visible approachable government they can feel confident in, and the health care system needs an approachable and open CMS to partner with them.

I remember standing on this stage two years ago and telling you that these would be the most important and meaningful years of my career. And they have been. I can’t think of a better job and a better place to be of service. I’ve been fortunate to learn from you and work with you. Simply said: my days have been filled with meaning every day at CMS. 

Never forget that for millions of Americans, you are what stands between them and access to better care; to security; and between them and freedom from injuries, sickness, and mental illness. With these patients and consumers in mind, there was nothing, as Acting Administrator, I wouldn’t do, no one I wouldn’t speak up to, no fight I wouldn’t enter.

I hope you felt that the CMS “political leadership team” and I represented CMS well and helped advance the work, all while helping the agency grow with and adapt to the times. I want to pause and thank the political leadership team that will be leaving public service in a few short days. They are an extremely strong group of leaders that have lead with compassion and high integrity. I will be eternally grateful for all that they have done and I’m proud to have worked so closely with each one of them.

It is remarkable, even in my short time here, to step back and think about how much you’ve accomplished. I will read a small subset of what has been accomplished…

• You completed one of the most far reaching implementations in health care– ICD- 10– without a hitch and with wide praise from physicians.

• You began implementing the complex laws in MACRA with class and to accolades.

• You have begun to change how we pay for care, launching, listening and re-launching new approaches to increase quality, improve coordination and teamwork, and reduce unnecessary variation.

• To wide opposition, you fought tooth and nail to enroll people in Marketplace With each bit of adversity, you got better and less likely to lose. Keep this tenacity.

• State-by-state you listened and solved problems so their residents could enjoy access to Medicaid expansion on terms that worked for them and supported principals that mean something to the program. Among many amazing and important things you did to put the principals back into the financing structure of Medicaid, you also made a difference in people’s lives, including a major advance heralded far and wide in the Tribal community.

• You made a commitment to health equity and to vulnerable populations like those people who are dually eligible for Medicare and Medicaid that began with the people and quickly drove into principals and actions.

• You took on tough issues, whether the cost of drugs, disparities among socioeconomic status, measurement, major safety concerns, or fraud. You didn’t back down from protecting people.

• You became the undisputed industry leader in data transparency, driving the industry to improve by providing the tools and listening to their needs.

• You used Medicare payments, quality and programs to accomplish important aims: investments in people with lower socioeconomic status, more investment in primary care and integrated mental health.

• You made a commitment to core operational execution. In responding to Freedom of Information Act requests, case work, appeals, technology, security, contracting or budgeting, and showed measurable progress in these areas.

• Our culture and commitment to one another is sound. Our employee engagement is at peak levels and climbing and we are among the very top across government.

• You demonstrated the power of relationships. Your work on the Hill as a trusted partner; your relationships with the media; the respect you garnered in the White House, with the Secretary, with other agencies, with advocates and partners and so many others represents a stark turnaround in how we are perceived. Frankly, the reputation of CMS feels as strong as ever.

• You invested in the future and peered around corners– whether on fraud prevention, better analysis of Medicare cost trends, prevention models, or cybersecurity. Thanks to our “guardian program” – no major cyber issues have occurred. I won’t be around to ask, but keep it up!

• And what makes me very proud is how you have innovated. Innovation to make sure people are treated with dignity using cool technology. Whether it’s Blue Button, MAGI in the cloud, automated Medicaid enrollment, TMSIS, cms.gov, Fraud prevention 2.0, or Compare site, CMS is a modern tech-enabled customer service organization that delivers the goods.

Not long after the HealthCare.gov challenges, the team started to get a number of successes under our belts. I had the opportunity to tell the White House and the Secretary to give CMS the hard problems, the big challenges, the mission critical projects the health care system is dependent on. And we would deliver. You have.

I am confident you are well positioned for whatever comes next. As strong as CMS is performing, you can do even more.

I had the opportunity to spend time with Seema Verma, the nominee for Administrator of CMS. If confirmed, she is excited to meet and work with the staff and I believe understands the great honor granted to her by the President-elect in appointing her to work at CMS. I told her what she will soon see: you are the strongest workforce in health care and, one could argue, what you deliver is at the highest levels of any government agency.

Welcome her the same way you welcomed me: Listen to the new team’s priorities and teach them yours.

All great organizations have one common trait: They are adaptable. They can take weaknesses and make them strengths. They know how to change with the times. They can absorb new people. Build new units. Find new ways of doing things. CMS has shown itself not to be the rigid organization that characterizes so many organizations—government or private sector. You’re good at what you do, but know how to use it to be nimble and adaptable. This will serve you well.

My ask of you is keep doing these things and more. The President-elect is certainly right on this point — winning feels good. To that I would add “…when your winning helps others.” Rack ‘em and stack ‘em. You keep doing the things we’ve done together—listen to the customer, work as a team, be intentional about your goals.

Let me close with a final note. Yesterday we celebrated Martin Luther King Jr. day. It is a day that always reminds us that for those gains we have made as a country, we need to be vigilant to make sure that no one in this country gets treated as less than an equal. That rights are what we fight for. I know you do that in your work every day.

There are also important rights you as federal employees and as individuals have. At CMS and in our government, no discrimination will ever be tolerated. There can be no intimidation. There will remain equal opportunity for all our people—LGBT, people of color, women, individuals with disabilities. No one can take that away. For those of you that ever have concerns, just speak up. CMS has and will always support you.

On behalf of President Obama, Vice President Biden and Secretary Burwell, I simply say thank you.

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