On December 17, 2013, CMS is hosting a call to provide an overview of the quality reporting provisions in the 2014 Physician Fee Schedule (PFS) final rule (which has not yet been released). The call will provide details on how an eligible professional or group practice can meet the criteria for satisfactory reporting for the 2014 Physician Quality Reporting System (PQRS) incentive and 2016 PQRS payment adjustment (including a discussion of criteria for satisfactory participation under the new qualified clinical data registry option). The call also will provide updates on the Electronic Health Record (EHR) Incentive Program and Physician Compare.
Monday, November 25, 2013
Goals, Priorities, and StrategiesOIG’s goals and priorities reflect the positive changes toward which we strive. Accompanying each priority listed below are illustrative strategies and indicators, as well as examples of OIG’s work to improve HHS programs and ensure the health and safety of the people served by them.
Goal One: Fight Fraud, Waste, and AbuseCritical to OIG’s mission is fighting fraud, waste, and abuse. We will continue to employ a multi-faceted approach of prevention, detection, and deterrence.
Priority: Identify, investigate, and take action when needed
Strategy. OIG uses data analysis and risk assessments of emerging issues to identify suspected fraud, waste, and abuse and deploy our oversight and enforcement resources. Our investigations result in criminal convictions and penalties, civil settlements, and administrative actions against those who commit fraud. Updates on OIG’s enforcement actions are available on our website. Looking ahead, we will build on successful enforcement models such as the Medicare Fraud Strike Force teams to enhance our enforcement results in other HHS programs. Key focus areas include: Medicare and Medicaid program integrity and waste in HHS programs. We will also continue implementing and refining protocols for self-disclosure of wrongdoing.
Priority: Hold wrongdoers accountable and maximize recovery of public funds
Strategy. OIG partners with the Department of Justice (DOJ) and HHS on Medicare Fraud Strike Force teams and other health care fraud enforcement activities through the Health Care Fraud and Abuse Control (HCFAC) program. On average, the HCFAC program recovers more than $7 for every $1 invested and protects programs through nonmonetary results, such as criminal convictions and exclusions of providers from participation in Federal health care programs. The latest HCFAC results are available in the annual HCFAC Report to Congress. We will continue to pursue all appropriate means to hold fraud perpetrators accountable and to recover stolen or misspent HHS funds. Key focus areas include: identifying and recovering improper payments and utilizing exclusions and referrals for debarment to protect HHS programs and beneficiaries.
Priority: Prevent and deter fraud, waste, and abuse
Strategy. OIG identifies fraud, waste, and abuse vulnerabilities in HHS programs and operations and advises HHS program administrators and policymakers on how tomplement effective safeguards. For example, our recommendations for strengthening HHS program administration and grants management and our grant fraud prevention training for HHS are summarized on our website. We also educate health care providers and provide them tools to help prevent fraud and abuse; these tools are available on our website. Looking ahead, we will apply the lessons we have learned about fraud vulnerabilities and effective prevention to HHS’s new and evolving programs. Key focus areas include: promoting compliance with Federal requirements and resolving noncompliance; advising HHS on key safeguards to prevent fraud, waste, and abuse, and assessing whether providers and suppliers, grantees, and others are qualified to participate in Government programs.
Goal Two: Promote Quality, Safety, and ValueHHS programs touch the lives of all Americans. OIG is committed to promoting quality of care and public safety in those programs and maximizing the value of Federal dollars invested.
Priority: Foster high quality of care
Strategy. OIG will continue to evaluate and recommend improvements to the systems intended to promote quality of care, exemplified by our series of reviews of adverse events (patient harm resulting from medical care), available on our website. We will also investigate and refer for prosecution cases involving abuse or grossly deficient care of Medicare or Medicaid patients. Looking ahead, OIG plans to expand our portfolio of work on quality of care. Key focus areas include: promoting quality of care in nursing facilities and home- and community-based settings, access to and use of preventive care, and quality improvement programs.
Priority: Promote public safety
Strategy. OIG recommends improvements to HHS programs to ensure adequate emergency preparedness and response; to protect the safety of food, drugs, and medical devices (summarized on our website); and to ensure that their grantees (e.g., Head Start and child care providers) meet safety standards. OIG will continue to prioritize fraud investigations that have public safety as well as financial implications and to look for comprehensive solutions. For example, we will continue to investigate prescription drug fraud cases and plan to work with leadership across HHS operating divisions to identify systemic solutions for this problem.
Priority: Maximize value by improving efficiency and effectiveness
Strategy. OIG’s findings and recommendations promote efficiency and effectiveness in specific programs and across HHS. We also work to ensure that HHS programs do not overpay for services or products relative to their value in the marketplace―for examples, see our “Spotlight on Bad Bargains.” Looking ahead, OIG also plans to assess programs intended to achieve value through care coordination and new ways of delivering and paying for care, as well as the reliability and integrity of quality, outcomes, and performance data.
Goal Three: Secure the FutureOIG will continue to address program and operational vulnerabilities that affect the long-term health and viability of HHS programs.
Priority: Foster sound financial stewardship and reduction of improper payments
Strategy. OIG reviews HHS’s annual financial statement audits and error rate reports. We also conduct targeted reviews to identify improper payments to be recovered and recommend management improvements to systemic weaknesses that contribute to improper payments. For example, our series of hospital audits (available on our website) identified common billing and payment errors and recommended fixes and recoveries of funds that were overbilled to the Government (overpayments). Looking ahead, OIG will continue to prioritize work on billing and payment errors by providers, effective program administration and contract oversight, and inefficiencies that result in wasteful spending.
Priority: Support a high-performing health care system
Strategy. OIG is working to support a high-performing health care system to foster better health outcomes and lower costs. OIG’s efforts include promoting quality, coordination, and efficiency. We provide technical assistance on safeguards to protect new and changing systems and programs from fraud, waste, and abuse. As HHS manages the transition to payments based on value rather than volume, we plan to conduct reviews and recommend changes to maximize overall value, protect program integrity, and foster value and high performance.
Priority: Promote the secure and effective use of data and technology
Strategy. Data and technology promise to drive improvements in health care and human services at lower costs. OIG will continue to advise program administrators and policymakers on promoting the secure and effective use of data and technology. OIG’s work in this area is summarized on our website. Looking ahead, key focus areas include: the accuracy and completeness of program data (e.g., Medicaid data), the privacy and security of personally identifiable information, and the security and integrity of electronic health records.
Goal Four: Advance Excellence and InnovationOIG strives to advance excellence and innovation in our own organization and operations.
Priority: Recruit, retain, and empower a diverse workforce
Strategy. OIG achieves its mission through its workforce. To identify, understand, and address the challenges facing HHS, we will continue to invest in our workforce by recruiting and retaining talented employees and by maintaining workforce excellence and the highest standards of professional conduct. We will foster a work environment that enhances productivity, innovation, excellence, and employee satisfaction and will cultivate a culture of continuous improvement. More information about careers at OIG is available on our website.
Priority: Leverage leading-edge tools and technology
Strategy. OIG maximizes the returns on our investments by leveraging data analytics and technology to inform our decisions about where to best direct our resources. For example, analysis of Medicare billing patterns has guided our decisions about where to deploy Medicare Fraud Strike Force teams and data analysis helps us to uncover fraud and conspiracies in specific cases, such as those highlighted in our Semiannual Report to Congress. Looking ahead, we will continue to use the best data, analytic tools, and technologies available to maximize the impact of our work.
Priority: Promote leadership, vision, and expertise
Strategy. In an evolving health and human services landscape, OIG focuses on building leadership and expertise to drive positive change. Our multidisciplinary approach affords us a range of tools to develop sound and innovative solutions. More information about OIG’s multidisciplinary workforce is available on our website. As HHS programs, technology, and the environment change, embracing innovation will help us maintain relevance and achieve impact.
The entire report in PDF:
Google Helpouts is a new video service by Google that connects individuals seeking help with experts via real time online video. Healthcare providers are using the platform to connect with Patients. Helpouts is built on top of Google’s Hangouts platform and is HIPAA compliant.
Google says it was created to provide “real help from real people in real time.” People who offer help through the service are calledproviders and can be businesses as well as individuals. Providers must pass a screening process in order to qualify as Helpouts providers.
Once approved, providers create and maintain listings that explain their offerings, qualifications, prices and schedules. Payments are made through Google Wallet and pricing is based either per minute, per session, or free. While Google charges 20% of the fees, health-related providers are not yet being charged. Helpouts Providers can be rated at the end of a session by the user.
So far Helpouts is limited to about 1000 providers, but Google is accepting requests for invitation.
Medicare Advantage Fact Sheet | The Henry J. Kaiser Family Foundation