Billions of tax dollars could be saved if the Centers for Medicare and Medicaid Services implemented the 25 top reforms recommended by the Department of Health and Human Services Inspector General. Doing so would also remove the stigma of ignoring watchdog recommendations than any other program or agency in the department.
The 25 recommendations are includes in the inspector general’s 2015 “Compendium of Unimplemented Recommendations” most likely to “positively impact HHS programs in terms of cost savings and/or quality improvements” if officials would put them into action.
The centers — which manages the Obamacare program in addition to Medicare and Medicaid — have accounted for 18 of the top unimplemented recommendations.
Inspector general officials estimate that one of their recommendations could save Medicare $15 billion over five years.
Those savings would result if the centers “reduced outpatient department payment rates for ASC-approved procedures to ASC payment levels for procedures performed on beneficiaries with low-risk and no-risk clinical needs.”
Another $2 to 4 billion could be saved by the end of 2017 if the centers reduced outpatient department payment rates for ASC-approved procedures to ASC payment levels.
The centers declined to implement the change because “adopting the recommendations would require legislation and that such a proposal is not currently included in the president’s budget.”
Ten of this year’s unresolved recommendations concerned ways of avoiding wasteful spending. There are also five recommendations designed to enhance “program integrity.”
In 2013, for example, the inspector general recommended that the centers and the Office of the National Coordinator “strengthen their collaborative efforts to develop a comprehensive plan to address fraud vulnerabilities in electronic health records (EHRs).”
The compendium incorporates the top 25 among all unimplemented recommendations, with the oldest dating back to September 2001. An estimated $3.87 billion would be saved if the centers “provide states with definitive guidance for calculating the federal upper payment limit, which should include using facility-specific UPLs that are based on actual cost report data,” the report said.
Three of the recommendations were unimplemented because Health and Human Services officials rejected them outright. All three are designed to correct federal billing and payment methods. Implementing this recommendation would save an estimated $16 billion, the inspector general said.
