Thursday, September 21, 2017

With WSJ Op Ed, CMS Seeks Innovative New Future for Center for Innovation; CMMI Comments Open til November 20

Several weeks ago, the head of the Center for Medicare and Medicaid Innovation - CMMI, or "The Innovation Center" - resigned, shortly followed by hints that CMS was setting up a renovation plan for CMMI itself.

That news is in full bloom now, with a centerpiece Op Ed in the Wall Street Journal by CMS director Seema Verma, and an official federal Request for Information, seeking comment on how CMS can best use the CMMI.
  • For the CMMI homepage announcement of the new direction initiative, here.
  • For the nine-page RFI, Request for Information, here.
    • Comments run 60 days, til November 20.
  • For Seema Verma's WSJ Op Ed, here.
    • For a trade journal article at Healthcare Dive, here.
    • For a trade journal article at Healthcare Informatics, here.
    • For a trade journal article at Fierce Healthcare, here.
    • For a trade journal article at Healthcare Finance, here.
    • For an article previewing the issues (September 12) from Manatt, here.
    • For a DePaul Journal of Health Care Law on the use and limits of CMMI authority, here (see PDF p. 14 ff).
    • Democratic lawmakers said that CMS has "no vision" for CMMI - here and here.
    • For a long article (Sept 23) at PBS, here.

The Verma Op Ed is relatively brief and shifts the CMMI emphasis from new mandated bundled programs (e.g. the comprehensive joint program) to relief from regulations through innovation waivers.  Consumer-based, market-based, state-based approaches will be highlighted.   Medicare Advantage waivers from regulations can be a focus.   Drug value payment programs will be on the table.  In an interesting bullet point in the RFI, "program integrity" CMMI programs might be created.

CMMI is an unusual legal entity.  It can waive essentially any Medicare law for the purpose of demonstration programs so long as the programs are intended to raise quality and not raise costs and don't eliminate existing benefits.   But there's no statement limiting the size and duration of demo programs (can a demo be nationwide for 20 years?)   Also, some such as PHRMA argue the law is written to point the "waiver of law" authority to demo programs, while CMS has interpreted itself as having authority to waive law also in later permanent program implementations, so long as they've met criteria (during the demo phase) on quality and costs.  

Steve Jobs v Henry Ford: Battle of the Business Idols

Prior director Patrick Conway often stated that the CMMI had a unique energy and "entrepreneurial spirit" inside CMS, and in one CMS-prepared video that was on Youtube, he wore a black t-shirt and began by saying, "I'm Steve Jobs and I'm head of the Innovation Center."   In her new WSJ Op Ed, Verma uses a different titan of industry, and notes that lawmakers didn't tell Henry Ford how to invent and assembly line and make better cars.  

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For some links to articles on CMMI's waiver authority, see here, here, here, here (by Dan Crippen, former head of CBO), and here.

Around the same time, September 26, HHS published a draft strategic plan for HHS for 2018-2022.  That website is here.  Comments are taken until October 27 on the 65-page plan.   Article on Politico (10/3/17), here.  Cloud archive copy of PDF is here.