@WLSA: Time to secure reimbursement is not a bottleneck, CMS says

By MHN Staff
02:57 am

Photo Credit: Paul Savage Photography

By Padma Nagappan

David Sayen, regional administrator for the western states with the Centers for Medicare and Medicaid Services, recalled meeting Rob McCray, president and CEO of WLSA back in 2006 when the iPhone was not even out yet: "Rob talked about wireless technology and I wondered 'what's this guy talking about?'" Sayen recalled during his keynote address at the start of the WLSA Convergence Summit in San Diego this week.

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Things have evolved quite a bit since then, Sayen said, to the point where he thinks the 'C' in CMS could represent "convergence", more than anything else.

Sayen said he is beginning to see pioneers embrace all sorts of wireless technologies that will lead them to the savings they seek. While he does not see CMS investing in mobile technologies, since it's for the providers to choose, he said CMS will drive the business so it delivers the right services to the consumers.

Asked about the delay in reimbursement and coverage, he said he doesn't think the time it takes to get coverage for a device is a bottleneck.

"Maybe we can expedite it but we're also the gatekeepers and need to ensure that only the essential technologies get coverage."

In CMS' view, current healthcare is producer focused but in the future it will shift to a patient or "people focus", which will change things. Payment is part of the problem now, with fragmented payment systems, the fee for service model and a lack of transparency. CMS will be part of the solution, according to Sayen, with the help of ACOs, a shift to payments per episode, value-based purchasing, patient-centered medical homes and transparency of data. CMS drivers that will propel change include incentive programs for quality reporting and EHR, partnerships for patients and ACOs for payments.

"On payment, yes, we're bogged down, but we have the opportunity to build around value," Sayen said. "I always talk about my wife's Rolex watch and my $100 watch. Hers needs to be cleaned every year, it's expensive and higher maintenance. Mine doesn't need expensive care, it keeps working. I liken value and quality care to my watch - affordable, reliable, matches need."

CMS wants to see better care, better health and lower costs for patients through improvements. Top among the payment system reforms that are being road tested is Medicare's shared savings program, a new approach to healthcare under the Affordable Care Act that will reduce fragmentation among providers, improve patient health and lower costs.

It will do this by encouraging accountability for the care given to Medicare beneficiaries who have the fee for service model; improve the coordination of care for Medicare parts A and B services; promote investments in infrastructure and restructure how care is delivered.

Another goal CMS is testing is the effect of bundling payments for multiple services that a patient receives during a single episode of care. It's approaching this in four ways -- only acute care hospital stays, acute care plus post-acute care, only post-acute care and potential payments for all in-patient services.

Sayen said CMS has selected 7 comprehensive primary care communities where it's supporting bundled payments as a test pilot. It's also launched a new nationwide public-private 'partnership for patients' initiative which has very specific goals -- a 40 percent reduction in preventable hospital acquired conditions; and a 20 percent reduction in readmissions within 30 days, both over the next three years. About 3,100 hospitals have signed the pledge to achieve these goals, which will result in a significant savings of $35 billion, fewer patient injuries and better recovery rates, by the CMS' estimate.

"Our system is not broken, it actually works well. What we need to focus on is how to make it better. EHR is the foundation for that," Sayen said. "EHR and mobile healthcare will help improve things so that care is integrated around a patient's needs."


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