The National Quality Forum on Wednesday named former deputy CMS administrator Dr. Shantanu Agrawal as its next president and CEO. He will take the place of Helen Darling, interim president and CEO, Jan. 30.
The National Quality Forum, a Washington, D.C.-based not-for-profit, nonpartisan organization, aims to improve healthcare through quality measurement and endorses quality metrics used in federal healthcare programs.
“NQF was created 16 years ago by private- and public-sector leaders out of their shared sense of urgency about the impact of healthcare quality on patient outcomes, workforce productivity and healthcare costs. These issues, and NQF's role to address them, are just as urgent today, if not more so,” said Agrawal, according to a press release. “I am honored to lead NQF during this exciting and pivotal time.”
The mission of the National Quality Forum differs from that of the Center for Program Integrity, but Agrawal's comments during public hearings hint at some areas he might address at NQF.
"It is important to remember that improper payments are not typically fraudulent payments," he said in May 2016. "Rather, they are usually payments made for items or services that do not meet Medicare or Medicaid's coverage and medical necessity criteria, that are incorrectly coded, or that do not include the necessary documentation."
Agrawal, appointed by the Obama administration in 2014, served as the director of the CMS' Center for Program Integrity, which tackles fraud and abuse issues in Medicare and Medicaid. It conducts audits and policy reviews of those programs, according to the center's website.
Before becoming CPI's director, Agrawal served as the center's chief medical officer from 2011 to 2013. In that role, he helped start initiatives involving new payment models and partnerships between the CMS and private payers, according to a biography on the agency's website.
Agrawal previously worked for three years as a management consultant at McKinsey, according to his LinkedIn profile.
That profile also lists him as a current assistant professor of emergency medicine at MedStar Health's Washington Hospital Center, and shows that for a stint in 2014 he served as a managing director at ChenMed, an integrated primary care practice for seniors.
During his tenure at the Center for Program Integrity, lawmakers were not always satisfied with the center's efforts to prevent and address waste.
“If you worked for me, you'd be fired this afternoon,” Rep. Chris Collins (R-N.Y.) said during a May 2016 hearing before the House Subcommittee on Oversight and Investigations, when lawmakers questioned Agrawal about reports by the Office of Inspector General demonstrating the agency's poor performance in addressing fraud and abuse.
"Fraud can inflict real harm on beneficiaries," Agrawal testified. "Beneficiaries are at risk when fraudulent providers perform medically unnecessary tests, treatments, procedures or surgeries, or prescribe dangerous drugs without thorough examinations or medical necessity." Preventing fraud, he added, improved healthcare quality while saving Medicare dollars.
In July, the CMS released a report stating that it had saved about $42 billion in fiscal years 2013 and 2014 through fraud prevention.
Jonathan Morse is now the acting director of the CMS' Center for Program Integrity, according to an automatic reply from Agrawal's email.