What’s New: A Look at Recent CMS and OIG Updates

The COVID-19 pandemic altered many plans for businesses throughout the United States. Many organizations were forced to delay initiatives and activities they’d scheduled months in advance. Some had to cancel them altogether.

Multiple government agencies also were negatively impacted by the pandemic, including those that serve and regulate the healthcare industry. In addition to the Centers for Disease Control and Prevention (CDC), which rapidly became the focus of media coverage, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services Office of Inspector General (OIG) scrambled to figure out how to alter their business strategies and programs while coming up with new ones to deal with the virus. 

Let’s look at recent critical updates from both organizations and the impact on healthcare organizations below:

Impactful CMS updates 

CMS, for example, continued to operate various programs while simultaneously developing and publishing COVID-19 vaccine policies and guidance, guidance for healthcare providers, and resources on vulnerable populations. Recently, though, the agency has been busy releasing information on new programs as well as updates on others.

Under its vision on using impactful quality measures to improve health outcomes and deliver value by empowering patients to make informed care decisions while reducing burden to clinicians, CMS announced the following updated goals:

• use its Meaningful Measures framework to streamline quality measurement
• leverage measures to drive outcome improvement through public reporting and payment programs
• improve the efficiency of quality measures by transitioning to digital measures and using advanced data analytics
• empower consumers to make best healthcare choices through patient-directed quality measures and public transparency
• leverage quality measures to promote equity and close gaps in care

Another recent CMS update entailed a new set of Meaningful Measures. Dubbed Meaningful Measures 2.0, they’re designed to address measurement gaps, reduce burden, and increase efficiency by:

• utilizing only quality measures of highest value and impact focused on key quality domains
• aligning measures across value-based programs and across partners, including CMS, federal and private entities
• prioritizing outcome and patient reported measures
• transforming measures to fully digital by 2025 and incorporating all-payer data
• developing and implementing measures that reflect social and economic determinants

CMS notes that since the launch of Meaningful Measures, it has reduced the number of Medicare quality measures by 18%, saving more than 3 million hours of time and a projected $128 million.

Approximately one month ago, the agency published its Fiscal Year 2022 Medicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals and Long-term Care Hospital Prospective Payment System Proposed Rule. It’s designed to supplement existing policies focused on closing healthcare equity gaps and supporting better access for patients to life-saving diagnostics and therapies during the public health emergency (PHE) and beyond. 

Pivotal OIG updates 

As with CMS, spring has been a busy time for the Health and Human Services Office of Inspector General, which is the biggest inspector general’s office in the U.S. government. It employs more than 1,600 investigators, attorneys and support staff. 

OIG is in the second year of its Strategic Plan 2020–2025, which includes 3 goals:

1. to fight fraud, waste and abuse
2. to promote quality, safety and value in HHS programs and for HHS beneficiaries
3. to advance excellence and innovation

It outlines federal health information technology goals and objectives with a focus on individuals’ access to their electronic health information.

The OIG is also examining home health providers’ usage of telehealth over the last year while the COVID-19 public health emergency flexibilities were granted. The goal of this project is to “determine which types of skilled services were furnished via telehealth and whether those services were administered and billed in accordance with Medicare requirements.”

 

In the near future, OIG will most likely develop strategies to address the problems reported by many hospitals in the agency’s Results of a National Pulse Survey.

According to the survey, many hospitals reported:

• difficulty balancing the complex and resource-intensive care needed for COVID-19 patients with efforts to resume routine hospital care
• experiencing financial instability because of increased expenses associated with responding to a pandemic and lower revenues from decreased use of other hospital services
• concern that the pandemic has led to greater mental and behavioral health needs among patients. Administrators anticipated that the needs for mental and behavioral health services at their hospitals would continue to grow and reported concern about meeting these needs.
• increased hours and responsibilities, along with other stressors caused by the COVID-19 pandemic, resulted in staff being exhausted, mentally fatigued, and sometimes experiencing possible post-traumatic stress disorder (PTSD)
• staff were “wearing many hats” while tackling multiple clinical and administrative responsibilities in light of gaps in staffing
• experiencing concerning staff shortages, particularly among nurses, raising concerns for hospitals about patient safety and quality of care.
• concerns about their financial stability as the COVID-19 pandemic had increased costs and decreased revenues

In reviewing these updates, it’s clear that having the right mix of healthcare experts working both on the front line and behind the scene is crucial to organization performance.

With our strategic approach to driving excellence within reimbursement, population health, and information technology across all care settings, we’re primed to empower your organization’s success today.