Berwick Outlines The Bright Side Of Health Reform For Finance Committee

Don Berwick, administrator of CMS, faces the Senate Finance Committee today
Don Berwick, administrator of CMS, faces the Senate Finance Committee today

Dr. Berwick will likely stay on message, according to a pre-released copy of his remarks, published in The Hill today. The focus of his presentation will likely be the great benefits of the 8-month-old reform law, called the Affordable Care Act. Here are some examples he cites:

Helping Medicare beneficiaries maintain access to life-saving medicines:

As a result of new provisions in the Affordable Care Act, people with Medicare are receiving immediate relief from the cost of their prescription medications. To date, 1.8 million seniors and people with disabilities who have incurred high prescription drug costs have received immediate help through a tax-free $250 rebate check to help reimburse them for out-of-pocket costs in the Part D prescription drug coverage gap known as the ―donut hole.‖ In addition, every year, people with Medicare Part D will pay less for their prescription drug costs in the coverage gap. Beginning in 2011, eligible Medicare beneficiaries will get a 50 percent discount on brand name prescription drugs in the coverage gap. By 2020, we will have closed the donut hole.

Making Medicare strong:

The Affordable Care Act contains many cost-saving provisions that will make the Medicare program more accountable and efficient,

protect the program from waste, and slow the growth in cost of the Medicare program. These important changes put Medicare on a path toward long-term sustainability and produce savings for the taxpayers by prolonging the life of the Medicare Hospital Insurance Trust Fund for an additional 12 years to 2029. These important changes will also benefit people with Medicare by keeping their premiums and cost sharing low.

New tools and authorities to fight fraud:

New authorities in the Affordable Care Act offer additional front-end protections to keep those who commit fraud out of Federal health care programs, as well as new tools for deterring wasteful and fiscally abusive practices, promptly identifying and addressing fraudulent payment issues, and ensuring the integrity of the Medicare and Medicaid programs. CMS is pursuing an aggressive program integrity strategy that will prevent fraudulent transactions from occurring, rather than simply tracking down fraudulent providers and pursuing fake claims. CMS also now has the flexibility needed to tailor resources and activities in previously unavailable ways, which we believe will greatly support the effectiveness of our work.

The Affordable Care Act provides CMS with additional tools to help the Agency tailor interventions to address areas of the most significant risk. Enhanced screening requirements for providers and suppliers to enroll in Medicare, along with oversight
controls such as a temporary enrollment moratorium and pre-payment review of claims in high risk areas, will allow the Agency to better focus its resources on addressing the areas of greatest concern and highest dollar impact.

Further, through the Health Care Fraud Prevention and Enforcement Action Team, or ―Project HEAT, CMS has joined forces with our law-enforcement partners at the Department of Justice and the HHS Office of Inspector General to collaborate and streamline our efforts to prevent, identify, and prosecute health care fraud.

Reducing improper payments:

While continuing to be vigilant in detecting and pursuing problems when they occur, we are also pursuing prevention of improper payments before they occur. We are reexamining our claims and enrollment systems to enhance our ability to prevent improper payments while still promptly compensating honest, hard-working providers. Due to prompt pay requirements in Medicare, our claims processing systems were built to quickly process and pay claims. CMS pays 4.8 million Medicare claims each day, approximately 1.2 billion Medicare claims each year. Nevertheless, with the new tools provided to CMS under the Affordable Care Act, we are steadily working to better incorporate fraud and improper payment prevention activities into our claims payment and provider enrollment processes where appropriate so we can prevent paying improper claims in the first place.

Reducing payment error rates in Medicare, Medicaid, and CHIP:

This Administration is strongly committed to minimizing waste, fraud, and abuse in Federal health care programs. We are keenly focused on the President’s ambitious goal of reducing the Medicare fee-for-service error rate in half by 2012.
High quality, low-cost Medicare Advantage benefits: This year CMS has improved its oversight and management of the Medicare Advantage (MA) program. The results for 2011, announced this fall, show that when CMS negotiates on behalf of beneficiaries and strengthens our oversight and management of MA plans, seniors and people living with disabilities will have clearer plan choices offering better benefits. In 2011, premiums are lower and enrollment is projected to be higher than ever before. As part of CMS’ national strategy for implementing quality improvement in health care, CMS is also instituting quality bonus payments for MA plans, providing an incentive for all plans to improve the care they offer to Medicare beneficiaries.

Improved customer service for people with Medicare:

I am proud of the hard work of CMS’ staff to implement the provisions of the Affordable Care Act on time. Nevertheless, I also recognize that much work remains in the coming days to administer our Federal health care programs and to implement new changes in the law. CMS can set an example for improving the health care system by working to improve ourselves as an Agency. We need to continually simplify and streamline our operations and work to reduce waste, both internally and externally. Diligence, agility, teamwork, and creativity should infuse CMS’ day-to-day actions as we remain mindful of the people we serve: public and private sector leaders, clinicians, hospitals, health centers, care organizations, and most importantly, the people who rely on our programs.

Reorganizing and streamlining CMS to prioritize coordinated program administration, innovation and fiscal responsibility:

Importantly, CMS underwent an internal realignment in April 2010, before I arrived, which consolidated Medicare operations in the Center for Medicare, as well as brought the bulk of Medicare and Medicaid program integrity activities under a new CMS Center for Program Integrity. Research and policy development functions have also been consolidated in a new Center for Strategic Planning. Because of this streamlining of operations, CMS is now able to pursue a more strategic and broader approach to program operations and program integrity functions at the Agency.

This program aired on November 17, 2010. The audio for this program is not available.

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Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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