Anesthesia Billing and Collections: CMS Exhorts Medicaid Directors
Author : Doc Clemens
CMS Exhorts State Medicaid Directors to Focus on Improving Delivery of Care Systems, Not Cuts
CMS officials urged state Medicaid directors to resist short-term fixes in favor of improvements in service delivery. Speaking at a conference of the National Association of Medicaid Directors (NAMD), CMS Administrator Donald Berwick told the group that there are other ways to contain costs. “We can reduce our ambition and cut, or we can improve our way to success.” Although some amount of cutting “is inevitable,” Berwick said, “it pales in comparison to the savings we can get with improvements in care.” Berwick said there are six major problem areas in the current health system that he believes impede improvements in service delivery: fragmentation and failure to coordinate care; failures in the care delivery process, including preventable hospital readmissions; over-treatment, including the unnecessary use of procedures and tests; excessive administrative costs; inappropriate pricing; and fraud and abuse. Cindy Mann, director of the Center for Medicaid and Children’s Health Insurance Program, said that current economic challenges provide an opportunity for states to make changes in the delivery of Medicaid services. “The window of opportunity could not be more apparent,” she said, adding that CMS and states should adopt a “shared, focused vision” and “yes, it is really time to redesign a system of care and payment.” Mann noted a number of ways in which CMS is attempting to improve Medicaid service delivery and payment reform. She said that the Agency has organized groups of CMS experts that will work with state Medicaid officials to help develop state-centered solutions to Medicaid problems. With regard to payment reform, she said that CMS actuaries are engaged in efforts to develop ideas for shared savings plans in individual states that can be adapted easily to other states. Mann also announced that later this month CMS will launch a new website (that will feature news and announcements from CMS regarding new Medicaid initiatives and regulatory actions.
In related news, NAMD released a report that outlines what state Medicaid directors believe to be barriers to innovation in Medicaid. The report said that many of Medicaid’s challenges are a result of failures in the broader US health care system, not intrinsic to Medicaid itself, and that problems include inefficiencies, duplication of services and uncoordinated plans of care. These problems will be further compounded by the expansion of the program in 2014 if Medicaid’s current policy and business practices remain unchanged.