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Dec 20 2012   2:42PM GMT

Two reports fault CMS HIT initiatives for waste and inefficiency

Posted by: EdBurns
CMS, gao, OIG, Pioneer ACO Model

The Centers for Medicare and Medicaid Services is having a bad week, as government watchdogs found fault with their HIT initiatives.

On Monday the Government Accountability Office issued a report saying that the CMS Innovation Center needs to make changes to its 17 new payment model programs to ensure there is no duplication. That same day, the Office of Inspector General issued a report faulting CMS for poor data collection practices related to its use predictive analytics technology for fraud fighting.

The GAO report expressed concern that CMS will end up paying for the same services twice (or potentially even three or more times) because many of the new payment models being tested by CMS share similar goals and requirements. For example, there is significant overlap between the Pioneer ACO program, the Advance Payment ACO Model and the Shared Savings program. Theoretically, providers could participate in multiple programs and draw multiple payments for the same services.

The OIG report did not necessarily say that the CMS predictive analytics anti-fraud program is failing. However, it did point out that CMS has experienced difficulty collecting and presenting in a consistent manner data to show that the program is working and generating a return on investment. This is important because it is up to the OIG to recommend whether or not to continue the program.

It would be easy to view these reports as setbacks in CMS’s efforts to bring new technology to bear on health care’s most intractable problems. Estimates of fraud suggest that it may cost the nation upwards of $80 billion each year. Some put that number higher. This is why CMS wanted to use some of the same fraud-fighting technology used by credit card companies. Meanwhile, the U.S. continues to struggle with the problem of poor treatment outcomes. ACOs are seen as one possible way to remedy the problem. Yet the reports knock both initiatives.

CMS is trying to take on a larger role in addressing health care’s greatest challenges during this era of reform. Some its efforts may pan out, while others may fail, as the reports point out. While its initiatives are generally aimed at positive goals, such as reducing costs and improving outcomes, it’s good that there are watchdog agencies to ensure CMS doesn’t spend recklessly in pursuit of these goals.

As for the specific concerns expressed in the report, only time will tell if CMS is able to remedy them.

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