PO Box 409095
Chicago, IL 60640
Length: 10 minutes, 28 seconds
Interviewers: Neil McLaughlin, managing editor, Modern Healthcare, and Todd Sloane, op-ed editor
Interviewee: Kerry Weems, acting CMS administrator, Centers for Medicare and Medicaid Services.
[00:00:02.00] Neil McLaughlin: Hi. Im Neil McLaughlin, managing editor of Modern Healthcare, and with me is Kerry Weems, acting CMS administrator of Centers for Medicare and Medicaid Services and also Todd Sloane, the op-ed editor of Modern Healthcare. So thank you for being with us today.
[00:00:25.25] Kerry Weems: My pleasure.
[00:00:26.23] Neil McLaughlin: Just a few questions here for you. One is when you came into this new position, you mentioned wanting to have a new era of transparency at CMS. Could you tell us a little more about that and what youd like to do in those regards?
[00:00:49.14] Kerry Weems: Yeah, Neil, I think that for CMS, one of the things that we need to be able to do is to act in a clear and predictable manner. And what that means isone of the things you have to remember about CMS is that we do most of our work through the remove of a contractor or through the remove of the state. So, we need to set forth clear rules for our business partners and clear delineations of that relationship. And then CMS needs to act on a clear and predictable path along those rules. Essentially, we need to do what we say were going to do and expect the same thing of our partners.
Some of it is just about setting the tone in the agency; during one of the initial news encounters that I had, I said I wanted to end cocktail hour press releases. What that meant wasthe humor in that asidewas that I think CMS needs to do its business out in the open. If weve got something to say, we should say it in the day, and have a discussion about itnot wait until later in the evening or on a Friday night to be able to put out news. If we have news, we should be proud of it, and we should be part of the public discussion. And thats what I mean by transparency.
[00:02:16.16] Neil McLaughlin: Theres been a lot of talk recently about private plans with Medicare and some of the problems with marketing that have come to light. How do you view this problem and what is CMS going to do about it?
[00:02:35.04] Kerry Weems: Well, as you may know, the seven plans were actually under compliance agreement, where they suspended marketing for a good deal of the summer. Those plans were audited and I personally read each one of those audits and made sure that it not only met the legal standard of the audit, but met my standard. And in some cases, I sent the auditors back to gather a little bit more information about the plan.
Those audits demonstrated that the plans had taken a number of steps to bring themselves into compliance with our rules. So we allowed them to begin marketing again, marketing for the 2008 plan year began on Oct. 1. One of the things that weve done is put into place an active surveillance network, to be able to make sure that the plans are complying with our requirements, especially as regards to marketing.
We think these can be very valuable products for some beneficiaries, but beneficiaries need to be informed and understand the plan that theyre in, to make it right for them and their health needs. And thats our primary mission here, is to make sure our beneficiaries are getting the care that they need in the setting thats best for them.
[00:04:02.24] Todd Sloane: A lot of our readers are, most of our readers, are healthcare providers. Theyreyou guys are, right now, in the process of coming up with so-called value-based purchasing, payment based on quality, in other words. And a lot of the research, because of the initial pay-for-performance programs around the country, has found that it rewards already high performers and doesnt necessarily lift all boats. How are you going to sort of overcome that obstacle, if it is one?
[00:04:40.23] Kerry Weems: You know, this is an area where the research is still proceeding and one where I think weve discoveredand I think a lot of people have told us thisthis is hard work. Were prepared to do that hard work. You know, one of the things that we do at CMS is do a lot of demonstrations and a lot of research. And one of the things that we are thinking about is how do we lift lower performers? So one way to think about a payment system that would do that is if you had just a purely linear relationship between payment and quality, well everybody knows what their increment is. But if you had a more [unclear] linear relationship, where poor performers didnt get much but you could step fairly quickly through the payment system to being a high-performer, the incentive changes a lot, depending on the shape of the curve. Thats one of the things were thinking about very carefully, is not just how do we provide that incentive, but how do we, as you say, lift all boats or, as it is in Lake Wobegon, you know, all the children are above average. Wed like all of our physicians and all of our providers to be above average. And I think we can envision a payment system that would get them that.
[00:06:14.07] Todd Sloane: Theres a lot of talk, this is probably further down the road than you are, but right now in [unclear] health policy research, about sort of paying differently. Instead of paying, essentially what a fee-for-service system, which is really what we have, is bundling payments around the patient, sort of care management, that kind of thing. I think Prometheus Payment is one of the big projects out there. Youve talked about that CMS looks out over the, over a long range and is planningis this something that you guys are seriously looking at right now?
[00:06:47.02] Kerry Weems: Its something were seriously looking at, you could see some of that in our demonstration projects for chronic-disease management, of paying for performance in that area, rather than just paying by procedure. One of the other things that were thinking of is how to group an episode of care and bundle that episode of care and pay for a quality outcome for that. Again, something that we need to carefully think through and demonstrate. But it would move us, rather than just paying for more, paying for quality and paying for an outcome, which is, in the end, what we all want.
[00:07:30.23] Neil McLaughlin: One of the things that our readers were most concerned about was the behavioral offset rule in the new, expanded DRG system thats coming down the pipe. Now theres been some changes at the behest of Congress about that. What can providers look for in the future regarding the possibility of upcoding some other payment irregularity?
[00:08:01.10] Kerry Weems: Well, what we want is, we want providers to make use of the MS-DRG system. What the Congress did was, yes, they reduced the behavioral offset, but more importantly, they left the payment system intact. We think that this payment system will allow us to pay on a more refined basis and we want to make sure that our institutional providers use it and use it well. Were going to, as the statute allows, look at the payments that we make under that system, and then make the appropriate adjustments when its time. We think that this let us keep the payment system in place, but also gave providers some breathing space to learn about the payment system and not fear the offset, like they did when we initially proposed it.
[00:09:02.25] Todd Sloane: Quality of care is, and this is just looked at globally, not just with what CMS is doing, but it seems like its a pretty confusing place for providers these days. Theres just too many organizations promoting somewhat different standards. You guys, I think, have been using the NQF process. What role can CMS legitimately play to kind of bring some order to this system?
[00:09:27.26] Kerry Weems: You know, thewere faced with the same problem in electronic health records. And the basic question is how do you set a standard? Well, this secretary believes it shouldnt be the governments job to set standards. But it is the governments job to set the table, and to invite everybody to it. So in the same way the American health information community has worked to establish consensus standards for electronic health records, wed like to do the same thing for quality measures in the inpatient and the outpatient setting so that we can get the organizations to come together, have a consensus about how to measure quality, do that in a standardized fashion, and I think that is really going to be one of the significant things that moves us to a quality-based healthcare system.
[00:10:24.10] Neil McLaughlin: All right. Thank you very much, Kerry Weems.
[00:10:27.06] Kerry Weems: My pleasure.