{"id":81,"date":"2015-04-15T09:30:59","date_gmt":"2015-04-15T09:30:59","guid":{"rendered":"http:\/\/www.ef.panicola.com\/?p=81"},"modified":"2015-04-16T09:15:16","modified_gmt":"2015-04-16T09:15:16","slug":"meeting-dr-shantanu-agarwal-cms","status":"publish","type":"post","link":"https:\/\/www.ef.panicola.com\/?p=81","title":{"rendered":"Meeting: Dr Shantanu Agarwal, CMS"},"content":{"rendered":"<p>Met with Dr Shantanu Agarwal, Deputy Administrator and Director, Center for Program Integrity<\/p>\n<p>Excellent discussion comparing notes on system integrity in Australia and US.<\/p>\n<p>CMS overall pays $1 trillion in program payments annually.<\/p>\n<p>Point estimate is that 12% are improper payments &#8211;\u00a0$48-52B per year.<\/p>\n<p>The observation was made that FFS schedules like MBS were more than administrative tools, but effectively were clinical guidelines given the powerful incentives that they provide for particular treatments.<\/p>\n<p>Analytic methods have been set and maturing for the last 5 years.<\/p>\n<p>Most challenging element is how to close loop on anomalous behaviour:<\/p>\n<ul>\n<li>Start with on-boarding\/educating newly enrolled clinicians (prevention)\u00a0using videos, literature, data, feedback.<\/li>\n<li>Engagement with providers needs to be longitudinal, long term, personal, especially around low value care.<\/li>\n<li>You need a credible (peer matched) messenger and data needs to be properly presented and matched.<\/li>\n<\/ul>\n<p>This <a href=\"http:\/\/content.healthaffairs.org\/content\/32\/6\/1078.short\" target=\"_blank\">Health Affairs article<\/a> describes a typical journey for a system Shantanu used to work for &#8211; ChenMed in Miami.<\/p>\n<p>Discussed:<\/p>\n<ul>\n<li>Fraud &gt; Abuse &gt; Waste &gt; Error continuum<\/li>\n<li>The agile human adversary<\/li>\n<li>Chasing value slide<\/li>\n<li>Gamma scoring methodologies<\/li>\n<li>Choosing wisely &gt; disinvestment<\/li>\n<li>Surgeon dashboard<\/li>\n<li>Surgeon selector<\/li>\n<\/ul>\n<p>Shantanu mentioned that\u00a0http:\/\/www.healthcostinstitute.org\/ were seeking to build out similar statistical presentations to our own, but had so far only developed cost-oriented metrix with no dimension for quality\/experience etc.<\/p>\n<p>Other references for the meeting:<\/p>\n<p><a href=\"http:\/\/www.medscape.org\/viewarticle\/764496\" target=\"_blank\">Reducing Medicare and Medicaid Fraud and Abuse &#8211; interview<\/a><\/p>\n<p><a href=\"http:\/\/www.hhs.gov\/asl\/testify\/2014\/06\/t20140625a.html\" target=\"_blank\">Statement to\u00a0Committee on Energy and Commerce<br \/>\nSubcommittee on Oversight &amp; Investigations<br \/>\nUnited States House of Representatives \u00a0on\u00a0Medicare Program Integrity: Screening Out Errors, Fraud and Abuse<\/a><\/p>\n<p>Powerpoint:\u00a0<a href=\"http:\/\/www.ef.panicola.com\/wp-content\/uploads\/2015\/04\/764496_slide_CMS_DrShantanuAgrawal.ppt\">764496_slide_CMS_DrShantanuAgrawal<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"http:\/\/www.ef.panicola.com\/wp-content\/uploads\/2015\/04\/cms.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-83\" src=\"http:\/\/www.ef.panicola.com\/wp-content\/uploads\/2015\/04\/cms.jpg\" alt=\"cms\" width=\"3552\" height=\"2000\" srcset=\"https:\/\/www.ef.panicola.com\/wp-content\/uploads\/2015\/04\/cms.jpg 3552w, https:\/\/www.ef.panicola.com\/wp-content\/uploads\/2015\/04\/cms-300x169.jpg 300w, https:\/\/www.ef.panicola.com\/wp-content\/uploads\/2015\/04\/cms-1024x577.jpg 1024w\" sizes=\"auto, (max-width: 3552px) 100vw, 3552px\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Met with Dr Shantanu Agarwal, Deputy Administrator and Director, Center for Program Integrity Excellent discussion comparing notes on system integrity in Australia and US. CMS overall pays $1 trillion in program payments annually. Point estimate is that 12% are improper payments &#8211;\u00a0$48-52B per year. The observation was made that FFS schedules like MBS were more &hellip; <a href=\"https:\/\/www.ef.panicola.com\/?p=81\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Meeting: Dr Shantanu Agarwal, CMS<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,13,3],"tags":[],"class_list":["post-81","post","type-post","status-publish","format-standard","hentry","category-behavioural-economics","category-integrity","category-note-meeting"],"_links":{"self":[{"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/81","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=81"}],"version-history":[{"count":5,"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/81\/revisions"}],"predecessor-version":[{"id":98,"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/81\/revisions\/98"}],"wp:attachment":[{"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=81"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=81"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ef.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=81"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}