CMS Releases its Roadmap for the Future

On Friday afternoon (Jan 16th), CMS released a set of documents to the public and policymakers that outlines its current healthcare reform programs, what it intends to do over the next 3-5yrs, and what it needs (from the US Congress) to accomplish it.

The press release was sent out via email and not yet (as of Jan 18th) posted on the CMS website.

Documents posted:

• Roadmap for Value-Based Purchasing
• Resource Use Measurement Plan
• Quality Roadmap Overview
• Qualty Measures Development Overview
• PAC Executive Summary Report
• PAC Full Report

All of these documents can be found here: CMS Quality Initiatives Information

The Roadmap for Value-Based Purchasing is an interesting read for anyone wanting to become familar with all the various VBP transformation efforts and demonstration projects that CMS has ongoing. CMS clearly states that VBP will extend beyond hospital acute care and into physician services, nursing homes, ESRD, and home health. This document outlines the work that has occured so far and the plan for each service category for the next few years.

The following are notes and comments from reviewing this document:

• CMS has an internal workgroup developing "resource use measures". Two measures that it identified for potential future use are imaging efficiency measures and hospital readmission rates for certain conditions. The readmission rate is not a surprise since this already being posted on the hosptial compare website. However, the imaging efficiency measures appears to be relatively new.
• The hospital VBP plan has already been submitted to congress.
• The physician services VBP plan will be submitted to congress no later than May 1, 2010.
• CMS acknowledges that its Part A and Part B payment structure creates artificial silos in the healthcare system and need to be broken down.
• CMS states that physicians and providers should be "jointly accountable for the care they provide, but also should be able to share in any resulting savings. This could include actions by CMS to revise the physician self-referral regulations."
• CMS is starting to demonstrated the level of transparency it is willing to go to. In this past year, CMS has tagged 52 nursing homes (4 in Indiana) on its nursing home compare website as "chronic under-performers". Using surprisingly strongly language, CMS states that it does this to "...encourage these facilities to transform themselves into environments of quality care, or turn themselves over to a management team that would do so."