CMS, Finance leaders look to curb Medicare waste

The Medicare agency and Senate Finance Committee leaders are calling for new guidelines on Medicare quality-of-care reviews after a new report said that federal dollars may be going to waste.

The Centers for Medicare and Medicaid Services (CMS) is unable to determine if Medicare quality-of-care budgets are excessive because CMS does not provide specific guidance on how much data should be recorded on quality reviews, according to a Government Accountability Office (GAO) report released Wednesday.

Medicare enters into three-year contracts with Quality Improvement Organizations (QIOs) in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands to review whether Medicare-financed medical services meet professionally recognized standards of care. The CMS QIO budget totals about $1.1 billion through July 31, 2011, with about one-fifth going toward reviews, including quality-of-care reviews.

“Without consistent information on the volume and costs for quality of care reviews, CMS cannot ensure that the budget for these reviews [...] for each QIO is appropriate,” the GAO report said.

A 2006 Institute of Medicine Report and a 2008 CMS report both identified weaknesses in CMS’s ability to compare costs across QIOs. CMS said it would work to implement GAO’s recommendations.

“The money we spend to ensure quality healthcare should make people healthier, and effective budget guidelines from Medicare will certainly contribute to making sure we meet that goal,” said Senate Finance Committee Chairman Max Baucus (D-Mont.)

“CMS has to do a better job of tracking this work so it can pay the appropriate amount and so taxpayers get what they’re paying for, which is better quality of care for Medicare beneficiaries,” said ranking member Chuck Grassley (R-Iowa).