Hardest Part of Affordable Care Act – CMS To Implement It

More important than the IRS, the enforcer of the Affordable Care Act, is CMS (Centers for Medicare and Medicaid Services) the implementer.

CMS is, historically, one of the most challenged administrative organizations in the US government.  A place where there are few islands of genuine efficiency to point to.

CMS is notorious as a regularity quagmire

  • Driven by outdated systems
  • Regionally managed
    • Through a network of private contractors.

For over a decade, the General Accountability Office (GAO) has reported to Congress every year –that CMS is the largest contributor to the federal overpayment identification and remediation program – totally a whopping $500B give or take a few billion –

If that number sounds familiar, it is exactly that planned saving from Medicare to fund the Affordable Care Act !!!

In fairness, the 2012 Report from GAO to Congressional Ways and Means does offer some glimmers of hope –

  • Recovery of $4B in fraudulent payments – reducing taxpayer losses to a mere $55B –
  • Identification of programmable “prevent conditions” and “controls”
    • As advocated by Reimagineamerica for the last two years –

It took a decade and two Presidents before CMS concluded the obvious.

  • Requiring providers, newly applying to the Medicare or Medicaid programs, to put up a surety bond  – would be a deterrent to fraudulent activity.
    • Not that they’ve figured out the process to implement that “Ah Ha” moment — yet!

So, it’s logical of course, that Congress should make CMS the lead agency to implement the Affordable Care Act.

  • Owner of the National Insurance Exchange
  • Designer of national insurance mandates
  • Supervisor of State Insurance Exchanges
  • Supervisor of the vast expansion of Medicaid
  • Home to 200 Boards and Commissions including the Medicare Cost Reduction Commission.

Assuming, by some magic that all of this will work?

In the private sector we know that magic is the illusionary outcome of lots of really hard work.

Whatever the ultimate fate of Obamacare – CMS plays too large and too central a role in American health care to be allowed to flounder on a sea of governmental complacency.

Congress and the Administration must pursue fundamental improvements in people, process and technology at CMS with an urgency that befits 16% of GDP.

Every dollar returned on that investment is a dollar of deficit reduction –

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