November 30, 2016
By Paul Westfall*
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), recently released its Work Plan for fiscal year 2017. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Topics include work addressing health care reform in Medicare and Medicaid.
- Accountable Care Organizations (ACOs): OIG has ongoing work examining ACOs in the Medicare Shared Savings Program including determining whether beneficiary assignment to ACOs and shared savings payments for assigned beneficiaries complied with federal requirements; describing characteristics of ACOs that performed well on measures and achieved savings; and assessing providers’ use of electronic health records to exchange health information to achieve care coordination goals.
- Quality Payment Program (QPP): OIG has a management review underway examining the early implementation of the QPP by the Centers for Medicare and Medicaid Services (CMS). The QPP is a significant shift in how Medicare calculates compensation for clinicians and entails the development of a complex system for measuring, reporting, and scoring the value and quality of care. OIG will describe the timeline and key milestones CMS has established and will identify the key challenges and potential vulnerabilities CMS faces during implementation.
- Delivery System Reform Incentive Payments (DSRIP): OIG has new work examining the DSRIP program by determining whether select states met federal and state requirements. Under Medicaid, DSRIP are incentive payments made under Section 1115 waivers to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality and cost-effectiveness of care, and improve the health of patients and families served.
- Accountable Care in Medicaid: OIG plans on new work reviewing accountable care models for compliance with federal and state requirements. Several delivery system reform initiatives in Medicaid, including, for example, medical homes and accountable care organizations, focus on accountable care and include elements such as implementing value-based payment structures, measuring quality improvement, and collecting and analyzing data.
OIG is focused on reviewing the economy, efficiency, and effectiveness of HHS’ health care reform programs. For all OIG planned work reviewing health care reform, OIG provides a consolidated list in an Appendix at the end of the Work Plan.
*We would like to thank Paul Westfall (Office of Counsel to the Inspector General, U.S. Department of Health and Human Services, Washington, DC) and Nazanin Tondravi, JD, MPH, LHRM (University of Miami Health System, Miami, FL) for respectively authoring and reviewing this email alert.