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CMS Research Update. Thomas W. Reilly, Ph.D. Deputy Director Office of Research, Development, and Information June 8, 2008. Overview. Background CMS R&D agenda Looking forward. Projections. Federal spending on Medicare and Medicaid is expected to total 4.6% of GDP this year - PowerPoint PPT Presentation
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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: [email protected]
