Late last month, the Centers for Medicare and Medicaid Services (CMS) announced that Jonathan Blum, Deputy Administrator and Director of Center of Medicare, would be leaving the agency after more than 5 years there. According to a note from CMS Administrator Marilyn Tavenner, Blum was the first political appointee to come to CMS under President Obama in March 2009. In August 2013, he was appointed to be CMS’ Principal Deputy, where he helped to “coordinate payment reform and cost-reduction strategies across the agency.”
Mr. Blum’s last day at CMS will be today, Friday, May 16th. Sean Cavanaugh, the current Deputy Director at the Centers for Medicare and Medicaid Innovation (CMMI), will take Blum’s position.
Policy and Medicine most recently wrote about Blum in regards to CMS’ release of the Medicare billing data of 880,000 physicians on April 9th. Blum stated that CMS had
“concluded that the data to be released would assist the public's understanding of Medicare fraud, waste and abuse, as well as shed light on payments to physicians for services furnished to Medicare beneficiaries, which are governed by statutory requirements that CMS must follow."
During his final week at the agency, Blum again stressed the importance of transparency as a tool for improving patient care and reducing cost. Inside Health Policy reports that on Tuesday, Blum stated that given the long rulemaking process, “often times the fastest way to change behavior is to share information.”
In addition to the Medicare payments data, Blum offered four examples of how data transparency is improving the health care system.
First, Blum said the U.S. Health and Human Services is testing whether “claims data can be used during natural disasters to identify people who depend on medical equipment that is powered by electricity so they can be provided generators or be moved to facilities with generators.” He also noted that "CMS, working with other public health officials through Health and Human Services, has used Medicare claims information with a very high degree of accuracy to identify very quickly those patients who are dependent on home ventilators [and] home oxygen machines.”
Second, Blum referenced “bundled payments,” a part of the Affordable Care Act, which refer to CMS paying for a patient's entire episode of care rather than just each stop in the medical system. In January 2011, CMS added oral and injectable drugs and lab tests to the dialysis bundle payment. “At the time, entities included in the bundle warned that bundled-pay could lead to an increase in blood transfusions,” Inside Health Policy notes. Blum turned this into a transparency achievement: "Sure enough, we saw a rise in blood transfusions," he stated. "But we were able to pinpoint precisely which patients and which dialysis facilities and which parts of the country which dialysis chains were driving those higher blood transfusions." Soon after revealing those facilities' data on their higher transfusion rates, their blood-transfusion rates came down.
In terms of patient care, CMS tracked a decline in heart attacks and strokes among dialysis patients. “CMS then gave that data to the skeptics of the bundle to prove the policy was helping patients and lowering costs.”
Third, Blum referenced CMS’ initiative to curb the use of antipsychotic drugs in nursing homes. CMS was able to identify facilities prescribing an unusually high number of the drug. As a result of discussions with industry, Blum noted there has been an approximate 15 percent decline in the use of antipsychotics in nursing homes.
Fourth, Blum compared this year’s release of Medicare payments to last year's release of hospital pricing data. Blum noted that last year the release was met with similar resistance from hospitals, who argued that "chargemasters" are only used to set prices for uninsured people and that the uninsured population is shrinking under Obamacare, and that hospital prices vary significantly because it is illegal for hospitals to share pricing information. Despite the protests, the information showed very divergent prices charged by similarly-situated hospitals.
"I was skeptical and I thought payment policy had more impact or hard-and-fast regulations had more impact, but I have come full circle," Blum said. "I have been convinced that there often times is more power in sharing data than simply changing policy.”