Trump Administration Delay On CMS Program Costs Jobs

Hundreds of highly skilled professionals have lost their jobs in recent months as the Trump administration drags its heels on funding a federally mandated program designed to curb government health care spending and improve care for seniors and people with disabilities.

The most recent five-year contract for quality improvement work for the Centers for Medicare & Medicaid Services ended in mid-July. Normally, a new round of funding would kick into place. Instead, CMS sent a terse email to the companies in late June, saying that their current “task orders” would end and that no extensions would be granted. 

The note said CMS was working on new contracts but that they wouldn’t be coming until September to November. In the meantime, the agency approved reduced funding for a limited scope of work through mid-October.

The announcement took quality improvement companies by surprise. CMS has never let the contracts lapse like that before, said Alison Teitelbaum, executive director of the American Health Quality Association, which represents quality improvement contractors. In the past, it has extended contracts to maintain funding and could have done so this time, she said. CMS did not use that option.

The agency responded to questions in an email but ignored a question about the delay in contracts, saying in its statement that “the procurement and award of the next five-year cycle of work is currently underway.”

Teitelbaum declined to speculate on the reason for the delay as did officials at Seattle-based Comagine Health, the nonprofit that holds the quality improvement contract in Oregon.

“CMS has indicated that it’s proceeding and will have a contract in place,” said Evan Stults, vice president of communications for Comagine Health. “We’ll take them at their word.”

The program has been around nearly 40 years and is mandated as part of the Social Security Act. There are currently 13 companies responsible for the work, and each covers several states, with only one company in any state. For the fiscal year ending this past July, it cost $934 million, according to the agency’s annual report to Congress.

The program aims to improve health care for Medicare beneficiaries and curb costs to prevent waste and protect taxpayer dollars. By all accounts, the program has been a success: It’s helped lower costly hospital readmissions, health care-acquired infections, adverse drug events and the overuse of drugs with harmful side effects.

An independent analysis showed the program saved $5 for every dollar spent, Teitelbaum said.

“That’s an incredibly wonderful return on the investment,” she said.

The program has two parts: One is centered on beneficiaries and case complaints, and the other is focused on helping providers improve their systems. CMS has delayed funding for the latter. No one seems to know why, though rumors have swirled about high-level resistance to the program within the Trump administration. The most visible effect of the delay in funding has been on jobs.

“The impact been pretty tremendous nationwide,” Teitelbaum said. “We did a survey, and we have about 25 to 30 percent reduction in staff so far.”

That translates to hundreds of people who will be hard to replace, she said.

“These people are trained quality improvement experts,” Teitelbaum said. “They help protect our nation’s seniors and some of our nation’s most vulnerable.”

Comagine Holds Contracts for Six States

Along with Oregon, Comagine Health holds the quality improvement contract for five other states -- Washington, Idaho, Nevada, New Mexico and Utah. The contract is worth $17 million a year. Separately, the nonprofit also does health care consulting and work with patients, providers and payers on quality improvement, care management, health information technology, analytics and research for other state and federal agencies. It has about 60 people in Oregon, with 20 focused on the Medicare contract. With its diversification, it was able to scramble to put staff in other jobs while the CMS contract is delayed.

“We are making the most out of this time and the staff and funding to strengthen our other programs,” said Meredith Roberts, executive director of Comagine Health in Oregon.

But that’s not been the case elsewhere. A month ago, the Kansas Foundation for Medical Care published an editorial expressing “deep concern about the immediate and long-term impacts” of the delay in funding. 

“The assistance we provide as part of the QIO program is at no cost to providers,” said Sarah Good, CEO of the Topeka-based company. “In our rural, resource-challenged delivery environment, this assistance is critical to helping providers navigate the increasingly complex regulatory and reimbursement environment ensuring their success and financial sustainability.

In Oregon, Comagine Health estimates it has saved the system nearly $4 million through patient safety efforts and about 3 million by stemming hospital readmissions. Roberts said the program is especially proud of saving providers tens of thousands of hours in administrative work so they can spend more time with patients.

“We are responsible for being stewards of the federal dollars that are coming to Oregon and our six states for Medicare fee-for-service beneficiaries,” Roberts said.

In May, the company in May submitted its proposal for the next round of funding. Now it’s waiting for the government’s response while fulfilling the limited “task orders.”  It received $2.7 million for mid-July to October to continue the immunization program and other work across the six states.

“It’s enough to get us through but it’s less (than full funding,” Stults said.

You can reach Lynne Terry at [email protected].


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