Washington, D.C. - Congressman Michael C. Burgess, M.D. (R-TX), Chairman of the Budget Committee Health Care Task Force, joined House Budget Committee Chairman Jodey Arrington (R-TX) in sending a letter to Comptroller General Gene Dodaro of the U.S. Government Accountability Office (GAO) requesting an investigation into the Center for Medicare and Medicaid Innovation (CMMI) and its effect on the federal budget.
On the costly effect of CMMI on the federal budget:
Increases in federal spending on health care in the United States—including Medicare and Medicaid—continue to exert significant pressure on the federal budget. At the same time, studies have found that higher levels of spending do not reliably lead to enhanced quality of care.
In 2010, the nonpartisan Congressional Budget Office (CBO) estimated CMMI would result in net savings of $1.3 billion over the ten-year budget window. A September 2023 report from CBO revised the agency’s prior analysis, estimating CMMI’s activities increased direct spending by $5.4 billion in Medicare, between 2011 and 2020.
In addition, CBO now currently projects that CMMI’s activities will increase net federal spending by $1.3 billion in Medicare, over the center’s second decade, which extends from 2021 to 2030.
On requesting GAO examine CMMI’s use of dedicated funding and assessment of its performance:
How CMMI has used dedicated funding to develop models and carry out other agency functions;
How much of CMMI’s first $10 billion mandatory appropriation did CMMI use prior to receiving its second $10 billion in funding in Fiscal Year 2020;
The status of CMMI’s testing of models, including models that have saved money or increased spending per the Administration;
How CMMI determines what types of providers to include in models, focusing on the discrepancy between the number of models focused on primary care physicians compared to specialists, and what frequency different providers, such as independent providers compared to large academic hospital systems, participate in models;
CMMI’s internal assessment of its performance goals to “develop and test health care payment and service delivery models to improve patient care, lower costs, and align payment systems to promote patient-centered practices”;
How many recommendations the Physician-Focused Payment Model Technical Advisory Committee (PTAC) has made and how has CMMI utilized such recommendations;
What process does CMMI use to forecast the potential budgetary effects of a proposed demonstration model prior to the model being approved and implemented;
What is known about the effect of the January 2021 updated Stark and Anti-Kickback regulations on participation in value-based care models;
The percentage of providers that remain participants in a model until the end, at what point do providers drop out and what are the reasons for that, including CMMI changing the model parameters for participants after the launch of the model, such as Retroactive Trend Adjustments; and,
To what extent does CMMI collect information from beneficiaries or providers about awareness and satisfaction with models.
Background:
Established by Obamacare with the goal of saving taxpayer money and improving the quality of care for beneficiaries, CMMI has failed to deliver on its mandate.
In 2010, the Congressional Budget Office (CBO) projected that CMMI would produce net savings over the 10-year budget window. CBO revised its analysis last year, finding that CMMI is not saving tax dollars but rather has increased federal spending by billions of dollars.
The letter follows a recent HCTF member roundtable focused on examining why CMMI is adding billions to the national debt, rather than generating budgetary savings as the program intended.
