CMS Moves Toward Greater Transparency

Historically, information on charges and costs for health care services has not been available to the public. Receiving a bill at the end of a treatment was generally the only way a person could find out the cost of health care services. CMS is working to usher in a new era of transparency and is very pleased to announce its next steps to create a more transparent health care system.

Today, CMS is releasing a request for public comment regarding physician-specific payment information. On May 31, 2013, a Florida federal district court lifted a 1979 permanent injunction that prohibited CMS from disclosing annual Medicare reimbursement payments to individual physicians.  In light of this recent legal development and our ongoing commitment to greater transparency in the health care system, CMS seeks public input on the best way to move forward. We are seeking input in three specific areas:

  1. how to properly weigh the balance between any potential privacy interest a provider has and the public interest in disclosure of Medicare payment information;
  2. what specific policies CMS should consider with respect to disclosure of individual physician payment data, especially with to prevent the release of any health information on any Medicare beneficiary; and
  3. what form any potential data release might take (e.g., line item claim details, aggregated data at the individual physician level).

In addition to releasing this request for public comment, CMS is also announcing four new qualified entities (QE). Created as part of the Affordable Care Act, the Medicare Data Sharing for Performance Measurement Program allows organizations to combine Medicare claims data from CMS with claims data from other payers to evaluate the performance of providers, services, and suppliers. The four additional QEs named today are Minnesota Community Measurement (MNCM), Wisconsin Health Information Organization (WHIO), Minnesota Department of Health (MDH), and the Center for Improving Value in Health Care (CIVHC). They will join the seven existing QEs in helping CMS improve quality, reduce costs, provide important information to beneficiaries to help them make health care decisions, and increase transparency.

Today’s announcements are only the latest of several efforts that demonstrate this Administration’s and this agency’s commitment to making health care more transparent.  In May 2013, CMS released information on the average charges for the 100 most common inpatient services at more than 3,000 hospitals nationwide, followed in June with the release of average charges for 30 selected outpatient procedures. CMS has also prioritized the provision of Medicare data to Accountable Care Organizations partnering with Medicare to improve care.

It is important to note that none of these efforts will result in the public disclosure of any information that could directly or indirectly reveal patient-identifiable information.  CMS is committed to appropriately the privacy of its beneficiaries.

CMS recognizes the potential for transforming the health care system that our data provides. By making our charge information public, we can help promote initiatives that can reduce costs and improve quality. This is only the latest step CMS is taking to increase transparency, but it won’t be the last.

Medicaid at Forty-eight

Cindy Mann, Deputy Administrator of the Centers for Medicare & Medicaid services and Director of the Centers for Medicaid and CHIP Services

Since 1965, Medicaid and Medicare have provided comprehensive and affordable health insurance to millions of Americans. Now, 48 years later, Medicaid continues to make strides towards connecting more eligible individuals with coverage and providing quality, affordable care. Now, as of 2013, 56.9 million people are covered by Medicaid, including 27.8 million children, 13.1 million adults and 15 million aged or blind/disabled persons.

 Key Medicaid Coverage Milestones

Children & Babies

                   •    Medicaid plays a key role in child and maternal health, financing approximately 40 percent of all births in the United States.

                   •    According to the Centers for Disease Control and Prevention, the rate of uninsured children dropped from 8.9 percent in 2000 to 6.6 percent in 2012, with millions gaining coverage – mainly through Medicaid and CHIP.

Elderly & Disabled           

•     Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare. Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare.

·                   •    Medicaid provides health coverage to over 8.8 million non-elderly individuals with disabilities, including people who are working or who want to work.

 Medicaid Moving Forward

As Medicaid turns 48, the program is evolving and there have been many important improvements to the program to help states across the country prepare for changes under the Affordable Care Act.  The Centers for Medicare & Medicaid Services (CMS) and states are partnering to implement streamlined eligibility rules and systems that will help ensure that eligible beneficiaries can enroll in the program that is right for them, whether Medicaid or coverage through the Health Insurance Marketplace.  And CMS continues to partner with states to improve the way care is delivered to help ensure Medicaid beneficiaries receive high quality health care services.  For example, over the last year, Medicaid has:

                 –  Issued guidance on a new state option for implementing integrated care models without a waiver that help states coordinate care in a fee for service delivery system;

-                                 –   Launched a new website to help states better implement long-term services and supports delivered through a managed care system;

-                                 –  Helped states and consumers to design new person-centered care programs and demonstrations and enhance current programs to improve coordination of care for Medicare-Medicaid enrollees;

-                                 –  Released major new funding opportunities for states and health providers and plans to design and test new delivery system models focused on multi-payer initiatives, new primary care initiatives, and improvements in birth outcomes; and

-                                -  Approved various initiatives to provide additional federal financial support to promote cost effective integrated care for individuals with chronic conditions and to help states improve access to home and community based long term services and supports. 

Medicaid also stands ready to serve more adults as states across the country take up the Medicaid coverage expansion as a result of the Affordable Care Act.  In 2014, states that expand Medicaid coverage to all adults with incomes at or below 133 percent of the federal poverty level can take advantage of 100 percent federal funding for the first three years and never less than 90 percent thereafter, thus extending Medicaid coverage to individuals who have historically been left out of the health insurance market.

CMS Releases App To Streamline Open Payment Program

by Peter Budetti, MD, JD

I’m excited to announce that we have released two apps to help physicians, manufacturers, and Group Purchasing Organizations (GPOs) track data for the Open Payments program, which was created through the “Sunshine” provision of the Affordable Care Act.  Use of the apps is entirely voluntary. Importantly, these apps are for information collection and storage only.  Having this mobile tool at your fingertips will make data much simpler to track and report.

The mobile apps are available to help physicians and others track payments and other information they receive throughout the year. This is intended to make annual reporting easier and ensure greater data accuracy.  CMS’ foray into mobile technology is about providing user-friendly tools for doctors, manufacturers and others in the health care industry to use in working with us to implement the law.  These two apps are an innovation option for doctors and industry to accurately and securely track their financial ties and other transfers of values as required under this transparency program created by the Affordable Care Act.

New Open Payments Apps available for download

The Open Payments law is designed to improve transparency to sustain patient care and trust as the highest priority by allowing the public to be informed about financial relationships that could influence the drugs, devices, biological, or medical supplies used in health care delivery.

To facilitate transparency and to keep patient care and trust as the highest priority, CMS has developed these apps to help physicians and others managed their oversight of information about their financial relationships that companies will report to Open Payments. We developed these apps to reduce the reporting burden by providing tools to simplify the tracking process and help improve data accuracy reporting for the industry (manufacturers and GPOs).

Using the Apps

Physician and industry users can track events and payments together using these apps for individual tracking purposes by either just the physician or just the industry user.  If they want to use the apps collaboratively, they can exchange many types of information, in real-time, to help ensure that physician information that the industry must supply to CMS in formal reporting such as  name, business address, and National Provider Identifier (NPI), is collected accurately. They can also collaborate on the interaction and payment that occurred to ensure everyone is on the same page.

Here is an example of how a physician could use the app to track payments received:

A physician receives a consulting fee from a drug manufacturer. The physician doesn’t have a reporting requirement under the Open Payments program, since all reporting is done by manufacturers and other companies, but she wants to be sure that the drug manufacturer accurately reports the consulting fee to CMS. Using the physician app, she can record a detailed summary of the transaction for her own records – by manually entering the data.

And here’s an example of how a doctor collaborates with the health care industry using the app:

The physician can use the “Read Quick Response (QR) Code” functionality that allows the manufacturer to create a record of the interaction and transfer it to the physician for her review.

Additionally, to help ensure the drug manufacturer correctly attributes the consulting fee to her, she can share her profile information with the drug company using the “Create QR Code” function. Months later, when she is reviewing the data the drug manufacturer reported to CMS, and before the data is made public, she can retrieve her original record from her mobile device and do a comparison to confirm that the information is correct.  If she believes the information that the manufacturer submitted to CMS about a particular interaction is not accurate, she can work with the manufacturer on correcting the information prior to publication.

Note that CMS will not validate the accuracy of data stored in the apps, nor will it be responsible for protecting data stored in the apps.  Reporting entities have sole responsibility for the accuracy and completeness of the data submitted to CMS under Open Payments.  

To download the mobile apps free of charge, for both Android and Apple platforms, users should visit the Google Play Store™ or iOS Apple™ Store and search for “Open Payments.” Once the chosen app has been installed, the user will be prompted to establish a password to ensure data security and privacy. That’s all it takes to get started.

Questions

This is an exciting time for CMS, as we’re able to harness the power of mobile technology to enable successful program implementation. Frequently Asked Questions about the apps and how they can be accessed and used are available on the Open Payments website. For any questions relating to Open Payments, contact the Help Desk at OpenPayments@cms.hhs.gov.

Connecting Kids to Coverage Outreach and Enrollment Grants

By Cindy Mann, Deputy Administrator and Director, Center for Medicaid and CHIP Services

Today, I’m thrilled that we are awarding nearly $32 million to support Connecting Kids to Coverage Outreach and Enrollment Grants.

Our ongoing partnerships with states and communities to connect eligible children to health coverage have taught us valuable lessons about how to conduct effective outreach – outreach that not only raises awareness of health coverage opportunities, but also gets eligible people enrolled.  We are applying these lessons to our work going forward so that Americans can get the health coverage they need.

These successes have also prepared the Centers for Medicaid & Medicaid Services for the historic expansion of coverage set to begin this fall, made possible by the Affordable Care Act.  Working closely with our colleagues in the states and at the federal level, these outreach and enrollment strategies will help us enroll millions of Americans in the Health Insurance Marketplaces and state Medicaid and Children’s Health Insurance Programs.

Today’s grants will build on this progress. Some of our outstanding grantees include:

  • The California Coverage & Health Initiatives will mobilize, coordinate and provide training and will work closely with the Spanish language community to increase health insurance enrollment for kids.
  • The Pima Community Access Program – As a past grantee, this group responded when Arizona reopened enrollment in its KidsCare program by setting up a call center and helped enroll 26,000 children whose families had been waiting to get coverage. This new grant will support their efforts to train over 600 organizations in four counties to help families with the new enrollment process.

Since 2008 children’s health coverage rates have improved dramatically, with millions gaining coverage mainly through Medicaid and CHIP — despite the economic downturn.

For the past four years we have worked tirelessly to reduce the number of insured children in our country. And thanks to these community groups that we partner with, we can see real results.

To view blogs by The California Coverage & Health Initiatives, and The Pima Community Access Program, please visit:

http://blog.cms.gov/

A new opportunity to connect kids to coverage in California

Suzie Shupe, Executive Director, California Coverage & Health Initiatives,

CCII 1

Edgar Aguilar, Program Manager, Children’s Health Initiative of Kern County

CCII 2

California is the most populous state in the union and home to more than 13 percent of the nation’s uninsured children. Since coverage is essential for making sure children reach their full potential, California Coverage & Health Initiatives (CCHI) is honored to receive a $750,900 Connecting Kids to Coverage Outreach and Enrollment Grant that will help us bring more low-income, eligible California children into health coverage.

CCHI has been working for over a decade to ensure children and families have the security of coverage and access to quality care. Our member organizations reach Californians in over 90% of California counties, helping to promote a robust culture of coverage and expand coverage to all children and families in our state. This video highlights who we are and why we are committed to this work.

This new funding will help us focus more of our energy and efforts on counties in California’s Central Valley and Inland Empire regions, where high concentrations of uninsured Latino children and their families live, work and play. CCHI, together with our local member organizations, will work closely with leading Spanish-language media outlets, trusted sources of news and information for Latino communities, to publicize community education and enrollment events. Helping these families learn about their coverage options and how to enroll is crucial to the success of health care reform. We know we can see more children grow up healthy and succeed in life as a result of the opportunities in the Affordable Care Act.

CCHI will also mobilize, coordinate and provide training and “on-the-ground” technical assistance to application assistors in targeted regions with the goal of enrolling tens of thousands of children into Medi-Cal. Collectively we have already covered more than 165,000 previously uninsured children through locally-funded programs and we connect another 125,000 children each year to the Medi-Cal and Healthy Families programs. Our statewide network has firsthand experience enrolling children into public coverage programs and we know that coverage for all children in California is a worthy and achievable goal.

We look forward to leveraging this new opportunity to get Californians the coverage they need, and to new opportunities just over the horizon to connect kids to coverage as a result of the Affordable Care Act. This work promises to move our state toward a brighter and more productive future, and CCHI is proud to be a part of it.

En español

Una nueva oportunidad para vincular a los niños a una cobertura en California
Suzie Shupe, Directora Ejecutiva, Iniciativas de Cobertura y Salud en California
Edgar Aguilar, Gerente de Programas, La Iniciativa de Salud para Niños del Condado de Kern

California es el estado más poblado de la unión y el hogar de más del 13 por ciento de los niños sin seguro médico en la nación. Dado que la cobertura médica es esencial para asegurar que los niños alcancen su máximo potencial, Iniciativas de Cobertura y Salud en California (CCHI por sus siglas en inglés) tiene el honor de haber recibido un subsidio de $750,900 del programa “Conectando niños a una cobertura”.  Estos fondos nos ayudarán a inscribir a más niños de bajos recursos que califican a la cobertura médica en California.

CCHI ha trabajado durante más de una década para que los niños y las familias tengan la seguridad de una cobertura médica y acceso a una atención de salud de calidad. Nuestras organizaciones miembros alcanzan a los californianos en más del 90% de los condados de California, ayudando a promover una cultura sólida de los beneficios de la cobertura médica y expandir la cobertura a todos los niños y familias de nuestro estado.

Estos fondos nos ayudarán a concentrar más de nuestra energía y esfuerzos en los condados de Central Valley de California y las regiones de Inland Empire, donde viven y trabajan muchos niños y familias latinas que no tienen seguro médico. CCHI, junto con nuestras organizaciones miembros locales, trabajarán en estrecha colaboración con los medios de comunicación en español, fuentes confiables de noticias e información para las comunidades latinas, para dar a conocer y anunciar los eventos educativos y de inscripción locales. Ayudar a estas familias a conocer sus opciones de cobertura y cómo inscribirse es crucial para el éxito de la reforma de la salud. Sabemos que podremos ver a más niños crecer sanos y tener éxito en la vida como resultado de las oportunidades en la Ley del Cuidado de Salud a Bajo Precio.

CCHI también va a activar, coordinar y proporcionar capacitación y asistencia técnica personal a las personas entrenadas para ayudar a la gente con sus solicitudes en las regiones especificadas con el objetivo de inscribir a muchos más niños en Medi-Cal. Colectivamente hemos asegurado cobertura para más de 165,000 niños que previamente no tenían seguro médico a través de programas financiados localmente y también vinculamos a otros 125,000 niños cada año a los programas Healthy Families y Medi-Cal. Nuestra red estatal  tiene experiencia de primera mano en inscribir a niños a los programas de cobertura pública y sabemos que la cobertura para todos los niños de California es un objetivo valioso y posible.

Esperamos aprovechar esta nueva oportunidad para que más californianos obtengan la cobertura que necesitan, y para las nuevas oportunidades en el horizonte que vinculan a los niños a la cobertura gracias a la Ley del Cuidado de Salud a Bajo Precio. Este trabajo promete mover nuestro estado hacia un futuro más brillante y más productivo, y CCHI se enorgullece de ser parte de los esfuerzos.

Pima Community Access Program is excited to partner with CMS for the Connecting Kids to Coverage Outreach and Enrollment Grant

Michal Goforth, Executive Director, Pima Community Access Program

A1

Pima Community Access Program is honored to receive this Connecting Kids to Coverage Outreach and Enrollment Grant.  With nearly $1 million from the grant, made possible by the Affordable Care Act, we will continue our longstanding efforts to ensure that children and families in our communities have access to the health care they need.

We know from experience that application assistance delivered by trusted members of the community is essential.  Working with the Arizona Medicaid agency, we operated a special hotline to help enroll children into Arizona’s Children’s Health Insurance Program (CHIP). Through that collaboration, we were able to access key data systems so we could answer questions, troubleshoot and expedite difficult cases.

As a result, in only 6 months, we were able to help enroll 26,000 children who had been waiting for coverage – and the state’s program will now be enrolling an additional 33,000 children.

This kind of help means the world to families in our community. Our staff recently took a call from a mother whose child had a serious unexpected illness. That child was in need of hospital treatment but was not enrolled in CHIP health coverage, even though the she was eligible.  Because of our direct connections, we were able to help her enroll immediately. Not a second was wasted. 

By preparing community organizations for the significant changes that will be taking place with the application and enrollment process, we are building on these vital lessons.

Under the grant, our organization and our 16 partners will provide in-person and web-based training for trainers who will, work with an array of 600 community organizations, schools, government agencies and faith-based groups. The project will provide tools that organizations can use to motivate Arizona families to enroll and maintain enrollment in the health insurance option that best meets their needs.

We are excited for this new opportunity to help enroll children of Arizona.

 

Administration announces $1 billion initiative to provide better health care and lower costs

By Rick Gilfillan, Director, CMS Innovation Center

Bringing down health care costs is a top priority. That’s why the Affordable Care Act contained an historic set of reforms designed to reward higher quality and lower the cost of care.  And we know that the best way to do that is the same way leading health care organizations do it: by making care better and more efficient.

We also know there are great ideas out there that can help push this work forward and that the kinds of innovative practices that make our health care system work better for everybody can come from any corner of the country. That’s why today we’re launching a $1 billion initiative through a second round of Health Care Innovation Awards.

These Innovation Awards will be given to organizations whose creative solutions to our most pressing health care challenges have the potential to serve as models for improving care and lowering costs across the country.

In November of 2011, we launched our first round of Health Care Innovation Awards by issuing a challenge to America’s health care providers, businesses, universities, and community groups.  We asked them to submit their proposals for how to get the most out of our health care dollars by delivering better care. That challenge resulted in more than 3,000 applications, from which a team of independent experts and HHS officials selected 107 promising innovations with the strongest likelihood of creating larger-scale, sustainable results.

And as we kick off round two of the Innovation Awards today, we’re already seeing encouraging results from a number of our round one recipients. The University of Miami, for example, is transforming school-based health clinics into medical homes to serve vulnerable children. These medical homes are connected to community health care providers and these children are already receiving tele-health consults for dermatology, psychiatry, and nutrition along with dental care.

Another recipient, Christiana Care Health Services, has used advanced data analytics to improve preventive care for patients with heart disease. Their comprehensive electronic registry allows providers to more quickly and accurately assess patients’ symptoms and needs based on similar occurrences in the past. This smarter preventive care doesn’t just prevent tragedies before they happen—it also saves money on hospital visits.

As with last year’s awards, we’re seeking out innovative practices that have a high likelihood of delivering better care and lower costs on a national scale.  The last few years have seen us make tremendous strides towards keeping health care spending in check, and a lot of that is thanks to innovations that have helped improve the quality and efficiency of care delivery and payment systems.

Across the country, private and public sector innovators are developing even more great ideas to improve our health care system.  And today’s announcement will allow us to take some of the most promising innovations and put them into action for the benefit of all Americans.  That’s good news for patients, for providers, for our economy, and for the future of American health care.

More information is available at: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Round-2.

Learn more about the key features of the Affordable Care Act.

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