CMS Research Update

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CMS Research Update

Thomas W. Reilly, Ph.D.Deputy Director

Office of Research, Development, and Information

June 8, 2008

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Overview

Background CMS R&D agenda Looking forward

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Projections Federal spending on Medicare and

Medicaid is expected to total 4.6% of GDP this year

Without changes in current law, Federal spending on Medicare and Medicaid will reach 5.9% of GDP by 2017 This is an increase of 30% in 10 years

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Projections, cont. Under current projections, the

Medicare Health Insurance Trust Fund will be insolvent by 2019

If the trend continues, Federal spending on Medicare and Medicaid will reach 20% of GDP by 2050 Roughly the same share of the

economy that the entire federal budget accounts for today

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Implications “Growth of this magnitude, if realized, would

substantially increase the strain on the nation’s workers, Medicare beneficiaries, and the Federal budget. These projections demonstrate the need for timely and effective action to address Medicare’s financial challenges.” (Annual Medicare Trustees Report: March, 2008)

Although not the only thing we need to address, a central priority for CMS’ research agenda is exploring and testing innovations to help slow the growth of program spending

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CMS research niche Conduct research and evaluations

of interest to the Administration and Congress to develop, assess, and refine Medicare and Medicaid policies

Develop, implement, and evaluate demonstrations to test innovations

Develop data infrastructure to enhance research capacity

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Current CMS Research Themes to Help Slow the Growth of Program Spending

1. Value-based purchasing2. Gainsharing3. Promote greater competition4. Bundled payments5. Patient-centered payment6. Refine and improve current payment

systems7. Chronic care and disease management8. Health promotion and disease

prevention9. Health IT infrastructure10. Data development and dissemination

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1. Value-based purchasing

Pay-for-performance demonstrations Hospitals Physicians Nursing homes Home health agencies ESRD facilities

Research on measuring provider efficiency

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2. Gainsharing Medicare Hospital Gainsharing

Demonstration Physician Hospital Collaboration

Demonstration

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3. Promote greater competition

DME Competitive Bidding Program Evaluation

Clinical Lab Competitive Bidding Demonstration

Evaluation of Competitive Acquisition Program for Part B Drugs and Biologicals

Comparative Cost Adjustment Demonstration

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4. Bundled payments

Acute Care Episode Demonstration

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5. Patient-centered payment

Post Acute Care Payment Reform Demonstration [For more background on this

demonstration, go to Ann Meadow’s session on “Medicare Post-Acute Care”]

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6. Refine and improve current payment systems

Study of revisions to wage index used in the hospital prospective payment system

Research on outpatient therapy payment alternatives

Study of geographic variation in Rx spending, for Part D risk adjustment

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7. Chronic care and disease management

Disease management demonstrations Seven demonstrations across 35 sites

Medical Home Demonstration Medicare Advantage studies, including

Special Needs Plans (SNP) evaluation Part D Prescription Drug Benefit

evaluation

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8. Health promotion and disease prevention

Senior Risk Reduction Demonstration

Cancer Prevention and Treatment Demonstration for Ethnic & Racial Minorities

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9. Health IT infrastructure

Electronic Health Records (EHR) Demonstration

Medicare Care Management and Performance Demonstration

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10. Data development and dissemination

Our goal is to build research capacity by making CMS administrative and other data available and understandable for health services researchers, within the limits of privacy restrictions and resource constraints

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10. Data development and dissemination, cont.

Primary approaches include:a. Develop research-oriented data filesb. Provide information and assistance

to researchersc. Improve data distribution process

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10. Data development and dissemination, cont.

a. Develop research-oriented data files Medicare Current Beneficiary Survey

(MCBS) Consumer Assessment of Healthcare

Providers and Systems (CAHPS) Medicare Health Outcomes Survey (HOS) Medicaid Analytic eXtract (MAX) Chronic Condition Warehouse (CCW) Part D data

[For more detail, go to Dan Waldo’s session on “CMS Databases”]

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10. Data development and dissemination, cont.

b. Provide information and assistance to researchers Research Data Assistance Center (ResDAC)

Assists in development of file formats for core research files

Develops researcher friendly documentation Training and liaison with research community Assists with the development of all requests for

CMS identifiable data

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10. Data development and dissemination, cont.

c. Improve data distribution processes Research Data Distribution Center pilot

(RDDC) This pilot will determine whether an outside data

distribution contractor can efficiently provide CMS data to external researchers, identify CMS operational issues and resolutions, identify contractor operational issues

Potential advantages to researchers include quicker turnaround, greater flexibility in data formats, ability to produce databases oriented toward researcher needs

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Summary of Current CMS Research Themes to Help Slow the Growth of

Program Spending

1. Value-based purchasing2. Gainsharing3. Promote greater competition4. Bundled payments5. Patient-centered payment6. Refine and improve current payment systems7. Chronic care and disease management8. Health promotion and disease prevention9. Health IT infrastructure10. Data development and dissemination

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Looking forward Trends in Medicare and Medicaid spending

are not sustainable We need to explore and test innovations to

help slow the growth of program spending CMS resources are increasingly

constrained, we need to prioritize our R&D investments

If you were in our shoes, what research would you focus on going forward?

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For More Information

Medicare demonstrations:http://www.cms.hhs.gov/DemoProjectsEvalRpts/CMS

Research reports and results:http://www.cms.hhs.gov/Reports/Reports/list.asp

Medicare and Medicaid statistics:http://www.cms.hhs.gov/researchers/statsdata.asp

ResDAC:http://www.resdac.umn.eduE-mail: resdac@umn.edu

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My contact Information

Thomas W. Reilly, Ph.D.Phone: 410-786-0631E-mail:

Thomas.Reilly2@cms.hhs.gov