Filed Under:Health Insurance, Individual Health

Weeds or flowers? Panel eyes Medicare innovation center

Sen. Orrin Hatch, R-Utah (AP photo/Jacquelyn Martin)
Sen. Orrin Hatch, R-Utah (AP photo/Jacquelyn Martin)

The head of a new government health plan efficiency laboratory promised lawmakers today that the research will give taxpayers a good return on their investment.

Dr. Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation (CMMI), oversees CMMI efforts to study how different approaches to paying doctors and hospitals might affect the cost and quality of health care.

CMMI is testing "accountable care organizations" (ACOs), bundled-payment programs, and other programs that are supposed to encourage providers, or provider teams, to provide a bundle of services for a condition, or for a whole patient, efficiently, rather than to maximize revenue by providing as many services as possible.

CMMI includes actuaries in an evaluation group that makes sure project managers are looking at the right variables, in a way that ensures that analysts can compare the results of different approaches on an apples-to-apples basis, Gilfillan testified.

The evaluation group "applies conservative evidence thresholds to assure that programs deemed successful represent high-value investments of taxpayer dollars," Gilfillan said.

Gilfillan appeared at a hearing on CMMI organized by the Senate Finance Committee.

Drafters of the Patient Protection and Affordable Care Act (PPACA) created CMMI in the hope of finding ways to hold down health care costs without reducing the quality of care or rationing access to medically necessary care.

Sen. Orrin Hatch, R-Utah, noted at the hearing that investigators from the U.S. Government Accountability Office (GAO) had suggested that, in some cases, CMMI might be duplicating other government resesearch projects.

When CMMI advocates talk about "'letting a thousand bloom,' I wonder if this is a euphemism for 'barely controlled chaos,'" Hatch said.

Gilfillan said some of what may look like duplication of effort is the result of CMMI efforts to respond to health care providers with different needs.

Gilfillan gave CMMI's "accountable care organization" (ACO) test programs as an example.

An ACO is a team of different types of providers that has agreed to accept a single payment for providing and coordinating care for a patient.

CMMI ended up creating one ACO test program for providers that are just getting used to the ACO concept, a second ACO test program for providers that have been involved with care coordination programs for years, and a third ACO test program for rural providers and physician-owned teams that needed to get paid in advance to have enough capital to participate in ACOs, Gilfillan said.

"Not one model works for everyone," Gilfillan said.

Also at the hearing, Sen. Pat Roberts, R-Kan., said he thinks a PPACA program that can penalize a hospital with a high percentage of discharged patients who return quickly is hurting patients.

Roberts said he heard of an older woman who went to the hospital with a sprained ankle, then had an apparent stroke when she was in the parking lot.

The woman went to the emergency room, but the physician who saw her refused to admit her, and she went home and died, Roberts said.

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Nichole Morford

Nichole Morford
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