May 2007

NAMSS has recommended that HIPDB and NPDB provider reports include a list of all entities that have queried a specific provider. NAMSS submitted these comments in response to a call for comments by the HRSA in the March 12 Federal Register.

NAMSS believes in the development of electronic databases to make the credentialing and privileging processes more efficient. The Healthcare Integrity and Protection Data Bank (HIPDB) and National Practitioner Data Bank (NPDB) allow providers and healthcare entities to obtain reports on a provider’s credentials and any past actions taken against the provider by state licensing boards. Providers are required to provide the information on themselves.

NAMSS recommended that HIPDB and NPDB query reports include a list of all entities that have queried a provider. Since providers are the ones who provide their data, there is the risk that an individual may knowingly omit a past employer or hospital affiliation to hide disciplinary actions taken against them. By including this list of entities, credentialing and privileging staff can compare the list of prior affiliations submitted by the provider to that of the list of querying organizations. Any discrepancies will act as a red flag for further follow-up on a provider’s past records.

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President Bush intends to nominate Department of Health and Human Services deputy chief of staff Kerry N. Weems, a 24-year veteran of the department, to be the next CMS Administrator, said the White House.

Weems's "wealth of experience as an advisor to several HHS secretaries and as a manager of large budgets and organizations will make him successful in the role of [CMS] Administrator," HHS Secretary Michael O. Leavitt said in a statement.

"He understands the large fiscal challenges facing Medicare and Medicaid and what it will take to strengthen and sustain those programs for the future. Further, he has been a leader in this department's efforts to accelerate adoption of health information technology and better financial management systems, which will be a valuable asset to CMS."

In picking Weems, 50, Bush bypassed several other candidates rumored to be considered for the job, including current acting administrator Leslie V. Norwalk and current acting deputy administrator Herb Kuhn.

Norwalk has been serving as acting administrator since the departure of Mark McClellan in October 2006.

Senate Confirmation

Weems must be confirmed by the Senate, and that may not take place for several months, according to sources. If he is confirmed, he would have about 18 months at the helm of the agency which runs Medicare and Medicaid and controls a significant portion of the nation's health care spending.

The tenure of the next CMS administrator is likely to be significantly quieter than it was for McClellan, who oversaw implementation of the Medicare prescription drug benefit. A major focus now at CMS is incorporating pay-for-performance and quality measurement programs into Medicare.

Surprised by Nomination

Little is known about Weems's health care views, since he has spent much of his time at HHS involved in budget matters. Health care industry sources were surprised Leavitt nominated a career HHS official rather than an individual with more knowledge of Medicare and Medicaid.

The CMS administrator is a highly visible position in the administration, and some sources were uncertain about the extent of Weems' health care knowledge.

"Kerry Weems has an extensive background in health policy," the National Association of Manufacturers said in a May 3 statement. "He has most recently served as Deputy Chief of Staff for [Leavitt] where he was responsible for strategies for health information technology, international health and health reimbursement."

"Before that, [Weems] was intimately involved in developing HHS's $700 billion annual budget. We look forward to working with him on value-driven health care reforms that emphasize wellness and prevention, health IT, transparency and consumerism."

Weems also has served as acting assistant HHS secretary for budget, technology, and finance and chief financial officer. He also has served as HHS deputy assistant secretary for budget. He received his bachelor's degree from New Mexico State University and his MBA from the University of New Mexico.

In a May 3 e-mail to CMS employees, Norwalk said the next CMS administrator must be willing to serve until the end of the Bush administration, a commitment she was not ready to make.

The White House also said Bush intends to nominate Tevi David Troy as HHS deputy secretary. Troy currently serves as Deputy Assistant to the President for Domestic Policy.

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Details of a proposed program that would link Medicare reimbursements for hospitals to performance were released by CMS.

"CMS's hospital payment policy moving forward will focus on purchasing value for the Medicare program, so that hospitals will receive differential payments as a function of their performance," the agency said in its options paper for the value-based purchasing program (VBP).

The draft described a "performance assessment model" that CMS proposes to use to score a hospital's performance, methods for computing a performance score and translating the score into an incentive payment, options regarding the basis and allocation of VBP incentive payment, the proposed selection criteria for performance measures and candidate measures for fiscal 2009 and beyond, options for transitioning from the current "Reporting Hospital Quality Data for Annual Payment Update (RQDAPU)" program, a proposed redesign of the data submission and validation infrastructure to support the VBP program requirements, and public reporting of performance results.

Starting in Fiscal 2009

The program would begin on Oct. 1, 2008, using as a foundation the performance measures in the RQDAPU program. However, CMS said that five current measures will not be included because of various clinical factors. For example, the "clinical evidence base" is changing for the measure of the receipt of beta blocker at arrival for acute myocardial infarction.

However, "newly developed measures would be tested prior to their introduction into VBP," the agency said.

Members of CMS's hospital pay-for-performance workgroup want to develop a purchasing plan that will be "the gold standard, not only for Medicare, but guidance for the private sector," Thomas B. Valuck, director of CMS's Special Program Office for Value-Based Purchasing.

Feedback

Commenters told CMS, for example, that "coordination of care" should be added to the measure set. Also, rewards should not be just for those who have attained their place on the top of scale, he said. The agency was told by stakeholders not to leave any hospital behind but to "raise all boats" and recognize improvement in those on the lower rungs.

Under the proposed VBP, a hospital would submit data for all measures that apply to its patient population and service mix, and would receive a performance score on each measure from zero to 10 based on either the attainment or improvement scoring criteria.

The hospital's overall VBP performance score would be determined by aggregating the scores across all VBP measures for which it has a minimum number of cases. The overall performance score, reflected as a percentage of points earned out of the total possible points for which the hospital is eligible, would be

A paper on the proposed options can be found http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/HospitalVBPOptions.pdf

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