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CMS Outlines Foundations Of Health Care Reform

Armen Hareyan's picture

The Centers for Medicare & Medicaid Services (CMS) today issued Quality Measurement, Resource Use Measurement, and Value-Based Purchasing Roadmaps for the traditional Medicare Fee-For-Service Program.

“These documents are intended to offer a vision for the future and potential options for CMS to pursue to improve the quality and value of health care delivered in the United States and to shift the Medicare FFS program away from paying providers based solely on the volume of services and instead paying them for quality and value of care,” said Kerry Weems, CMS acting Administrator.

Health care today represents one-seventh of the economy with spending totaling more than $2 trillion annually. By 2017, the nation is expected to spend roughly $4 trillion on health care: 21 percent of gross domestic product.

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Medicare costs are continuing to skyrocket as well. Last spring, the Medicare Part A Hospital Insurance Trust Fund had been projected to go bankrupt in 2019, 11 years from now. The Medicare chief actuary recently observed that because of the current economic crisis, this date could be moved three years earlier - 2016.

“It is incumbent on us to use the lessons we’ve learned with many of the tools we have implemented to help the nation’s health care leaders as they look to improve the health care system in a time that’s even more critical because the projected rate of growth in health care costs is climbing at an unsustainable rate,” said Weems.

The papers linked to www.cms.hhs.gov/QualityInitiativesGenInfo/ outline the activities that CMS has undertaken to implement value driven health care, including summaries of the various projects to test the policy and concepts designed to provide high quality, affordable health care. The papers provide steps to implement quality and resource use measurement to improve the delivery of care and offer a roadmap to assist in implementing value-based purchasing for Medicare’s FFS payment systems.

These papers are also intended to provide information to policy makers about the demonstrations and pilot programs that are already underway and to articulate the overarching principles guiding further efforts.

The concept behind value-based purchasing is to encourage care delivery patterns that are not only high quality, but also cost-efficient and to move away from the traditional FFS payment systems that pay health care providers to perform services without regard to their quality. In order for a value-based purchasing payment to function, it must be based on standardized quality measures provide information about care that is accurate, reliable, and relevant in a patient-centered way and also based on resource-use measures that can evaluate health care performance in a way that enables comparisons of how efficiently health care is delivered.