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Researchers Urge Faster Pace for Innovation Center Spending

By Kerry Young, CQ Roll Call

May 21, 2015 -- Given Republican distaste for the Affordable Care Acct, the Centers for Medicare and Medicaid Services (CMS) should consider stepping up the temperate pace of spending for the innovation center created by the measure, said researchers in a paper published Wednesday in the New England Journal of Medicine.

The program has obligated only about a third of the $10 billion provided for it, noted Lawrence P. Casalino and Tara F. Bishop of Weill Cornell Medical College in an assessment of the work from CMS’ Center for Medicare and Medicaid Innovation. The health law calls for this initial tranche of funds to be expended by the center by fiscal 2019.

A recent Congressional Research Service report showed the center, called CMMI or the Innovation Center, has increased the flow of money to participants in its test programs, with an obligation of $1.64 billion slated for the fiscal 2016. Still, given the political climate, it “may be better to spend the money sooner rather than later,” the authors wrote in an article published Wednesday.

The center’s mission actually fits well with a drive by many GOP lawmakers to try to structure medical payments to improve care, a view expressed in the Medicare payment overhaul legislation (PL 114-10) enacted last month, Casalino and Bishop said. But its origin as part of the 2010 health law and GOP skepticism of government as a driver of innovation may doom the program, despite the health law’s call for Congress to act again to extend the center’s work beyond fiscal 2020.

“Republican control of Congress and possibly the presidency make CMMI’s future uncertain,” the authors said.

Some of the center’s more promising projects to date include funding large tests of accountable care organizations, or ACOs; bundling payments for certain treatments; and a move toward a comprehensive primary care approach, according to Casalino and Bishop.

“Indeed, the effect will be substantial if even one of these programs succeeds,” they said.

In a separate article published Wednesday in the New England Journal of Medicine, CMS officials cite ACOs and projects that use episode-based care as among the key areas of focus for the center’s next five years. Earlier this month, Casalino published a companion article to one from CMS officials in the Journal of the American Medical Association regarding nearly $385 million in savings claimed from the center’s Pioneer ACO model.

The results of ACOs may be more easily measured than for other CMMI-funded projects, Casalino and Bishop said Wednesday in the New England Journal of Medicine. Parsing the effects of some other work can be challenging, due in part to the difficulty of standardizing data collection among large numbers of organizations involved in certain projects.

Casalino and Bishop cite as an example the Partnership for Patients program, which includes most of the nation’s hospitals. The program aims to prevent hospital-acquired infections and lower the rate of readmissions. The number of participants—more than 3,700 hospitals—is one factor making it "difficult to definitively determine the impact of CMMI's broad, collaborative quality-improvement programs,” the authors said.

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