CMMI, Senate committee lock horns over innovation projects

The Center for Medicare and Medicaid Innovation (CMMI), created by the Affordable Care Act (ACA) as a testing center for creative new care delivery and healthcare payment models, is being called to task by the Senate Finance Committee for its focus and its use of its budget.

CMMI’s director, Richard Gilfillan, MD, testified last week before the Senate finance committee, which is charged with evaluating the innovation center’s progress to date. In his presentation, Gilfillan noted the center’s progress in developing 41 pilot models, including nine accountable care initiatives, eight bundled payment models and multiple demonstration projects for primary care transformation, best practices and dual-eligibles.

The ACA requires CMMI to modify or terminate its projects, based on an evaluation of their success. CMMI “continuously monitors progress and results in order to quickly identify successful and unsuccessful models,” Gilfillan said during his testimony, adding that the “testing period for most models is typically three to five years.”

But finance committee members expressed concern over the innovation center’s structure, workflow and budgetary spending, especially since it will take several years before many of the center’s initatives can be judged successes or failures.

Committee Ranking Member Sen. Orrin Hatch (R-Utah) likened CMMI’s tasks to “barely controlled chaos,” saying its basketful of initiatives is an uncoordinated approach with too many projects that will take several years to evaluate.

“I fear you are trying to do too much at one time,” Hatch said during the meeting. “It seems to me that CMMI would function best if it would pick a few initiatives—such as accountable care organizations (ACOs) or bundled payments—and really devote the time to those initiatives to make sure they actually work and have the intended consequences of lowering costs and increasing quality and efficiency.”

Several finance committee members expressed specific concern about the new Medicare payment models, since much of the touted savings for Medicare and Medicaid under the ACA has been tied to successful payment reform.

As more of the nation begins to feel the pinch of sequestration, CMMI has been criticized for too many redundant projects. In November 2012, the Government Accountability Office had told CMMI to employ better project coordination to keep their projects from overlapping with the Center for Medicare & Medicaid Services’ own Quality Improvement program and other initiatives.

Sen. Chuck Grassley (R-Iowa) restated this concern in the committee meeting: “We’re in the middle of sequestration, [and] agencies have been told to scale back, so my first question to you is do you think it’s appropriate for CMMI models that clearly overlap?” he asked Gilfillan.

Sen. Max Baucus (D-Mont.) pointed out the conundrum between diligent testing time and wide-scale projects that may discover a good model faster. “Some of the tested models will be successful and others won’t,” he said at the meeting. “We must continue trying new ideas, learning from mistakes, and building on our successes. We can’t wait a decade to develop a model, and then implement it nationally. We need to allow proven ideas to ramp up and spread rapidly without waiting for Congress to act.”

Hatch and other Republicans have long criticized CMMI’s $10 billion budget, appropriated by the ACA for 2011-2019. During the committee meeting, Hatch questioned some of CMMI’s expenditures, including the payscales of its employees and the purchase of expensive office furniture.

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