Senators Ask CMS To Reconsider Decision To Delay Second Phase of Disease Management Pilot Program
Several senators in a letter last week asked CMS to reconsider a decision to delay implementation of the second phase of a pilot program that provides disease management services to Medicare beneficiaries with chronic conditions, CQ HealthBeat reports.
In February, CMS decided to delay the second phase of the Medicare Health Support program, which began the first of three phases in 2005, because preliminary results indicate that the program "is not meeting the statutory requirements of improved clinical quality outcomes, improved beneficiary satisfaction and the achievement of financial savings targets." The first phase, which provides services to 68,000 Medicare beneficiaries, will end this year, with the implementation of the second phase dependent on the results of an independent evaluation that would not conclude until 2011 or 2012, a CMS spokesperson said.
In the letter to acting CMS Administrator Kerry Weems, Sens. John Kerry (D-Mass.), Edward Kennedy (D-Mass.), Bob Corker (R-Tenn.) and Lamar Alexander (R-Tenn.) wrote that "suspending, even temporarily, the nation's broadest care management program for Medicare fee-for-service beneficiaries makes no clinical or fiscal sense." According to the senators, Medicare beneficiaries who receive services through the program are "satisfied" and are "receiving demonstrably improved care," and a delay in the implementation of the second phase "not only poses an obvious financial burden but, much more importantly, creates serious health risks for the Medicare beneficiaries already enrolled and heavily reliant on MHS."
The senators also questioned whether "results from the MHS program merit its suspension." They wrote, "As we understand it, the methodology employed by CMS in making these statements is invalidated, incomplete and open to interpretations rather than specific data," as required by the 2003 Medicare law, which mandated the launch of the program. The letter requested a response from CMS by March 31.
CMS spokesperson Peter Ashkenaz said that the agency plans to work "as expeditiously as possible" on the evaluation of the program and that all organizations involved "knew that the program was to be evaluated before CMS could proceed to the next phase" (Carey, CQ HealthBeat, 3/17).
Medicare Bill
In related news, Senate Democrats might use the fiscal year 2009 budget reconciliation process, which allows legislation to move through the chamber without the threat of a filibuster, to pass a Medicare bill, but they have not made a final decision on whether to use the process, CQ Today reports. Democratic conferees on the FY 2009 budget resolution will make the decision after Congress returns from spring recess on March 31. Senate Finance Committee ranking member Chuck Grassley (R-Iowa) warned Democrats against the use of the process. He said, "If the Democratic leadership insists on using budget reconciliation for the Medicare bill, they will fail to get a bill enacted."
The Medicare bill likely would include a provision to prevent a 10.6% reduction in physician reimbursements scheduled to take effect in July and could include a reduction in Medicare Advantage plan reimbursements, according to CQ Today (Wayne, CQ Today, 3/17).
The Medicare bill also could include a measure that would establish an independent entity to compare the effectiveness of medical treatments. Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Budget Committee Chair Kent Conrad (D-N.D.) have begun to draft such legislation, which they plan to introduce after Congress returns from spring recess. In the House, Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) has proposed similar legislation. According to CongressDaily, although almost "no one disputes the basic goal" of such legislation, "fractures emerge" on the source of funds for the independent entity and on "how the findings will be used" (Johnson, CongressDaily, 3/17).
Related Broadcast Coverage
CBS' "Evening News" on Monday reported on a new rule under which Medicare no longer will reimburse hospitals for the treatment of certain preventable conditions, and a similar regulation that the Pennsylvania Medicaid program plans to implement. The segment includes comments from Weems, actor Dennis Quaid, Pennsylvania Gov. Ed Rendell (D), Ronald Paulus of the Geisinger Health System in Pennsylvania and a patient who experienced a medical error during heart surgery (Andrews, "Evening News," CBS, 3/17). Video of the segment and expanded CBS News coverage are available online.
