Innovation that Works

When the Affordable Care Act (also known as Obamacare) waspassed into law there were those who liked it and those who didn’t. There were,however, some parts of the law that people on both sides liked. One of thoseparts that found a large following of fans was the creation of the Center forMedicare and Medicaid Innovation (CMMI).

CMMI was set up to be a petri dish for trying out new andmore efficient ways to administer health care. To do this, CMMI was allowed tobe free of many government regulations, use ideas from many sources, sign upproviders who wanted to try out these new approaches and carefully analyze theresults. What a great idea . . . rather than the government overhauling a hugepart of a health care process with an untried approach and the accompanyingunintended consequences, you could run a test, see what works and what doesn’tand then take the proper steps to implement the tested approach.

CMMI tests were intended to be small and specific and tohave a definite end. They were tasked to be well planned with well-definedcriteria for success. This program was a new and powerful tool, and as it grew,it began to be used beyond its original intent. Rather than a testing platform itwas used, in some instances, to implement nation-wide changes to Medicare andMedicaid, without Congressional oversight. Both the Obama administration andthe Trump administration used CMMI to make some test programs permanent, effectivelychanging the health care system without Congressional approval. This was doneby making the size of the test large, so it impacted a large swath of thenation or by having a very fast phased rollout, faster than the results of theinitial test could be effectively evaluated. They also made providerparticipation mandatory to ensure large participation. All of these approacheswent way beyond the basic intent of the CMMI.

While this approach was a great way to quickly initiatechange, it avoided the checks and balances of both the judicial and legislativebranches of the government. The most egregious of these tests were opposed bypatients and providers alike and these groups were often successful in stoppingthe widespread adoption of the changes, but it became evident that legislationwas needed to ensure that the constitutional checks and balances weremaintained.

Congress has acted . . . legislation has been created and introducedin the House. The Bill, HR 5741 (IH) - StrengtheningInnovation in Medicare and Medicaid Act, (a bi-partisan effort) mandatesthat certain “rules of the road” must be in place to ensure that any tests havea defined duration and that any final changes to our health care system are putin place with Congressional approval.

CMMI is a powerful tool that can have both good and badimpacts on our access to quality health care. This new legislation willestablish safeguards that will ensure CMMI stays within the initial intent ofthe program. It will protect both providers and patients and will allowinnovation to be implemented within the checks and balances of our government.

I will keep you apprised of its progress and urge you toencourage your Senators and Representative to support this legislation.