In December, the Centers for Medicare & Medicaid Services (CMS) finalized a demonstration program to test new ways for Medicare to pay hospitals that perform heart or hip surgeries, but more recently, CMS has withdrawn that rule and canceled the project. As part of the demonstration program, CMS also announced the creation of an ombudsman to serve people with Medicare in this model and other similar programs—a move applauded by Medicare Rights.
Medicare Rights wrote a letter last week to encourage CMS to move forward with the creation of the ombudsman, even though the rest of the rule was rescinded. Even though this model is not moving forward, there are other alternative payment models currently underway to test strategies to enhance the overall quality of care provided by creating new incentives for providers.
Medicare Rights has been generally supportive of value-based demonstrations, because we believe they can benefit both taxpayers—by spending Medicare dollars more wisely—and people with Medicare—by improving people’s care and well-being. Still, we have repeatedly urged CMS to rigorously monitor patient experiences in these new care models and to more thoroughly educate people about how their care may or may not change and what their rights are as a Medicare recipient.
An ombudsman can serve as an effective, centralized resource for this monitoring. Typically, ombudsman programs track questions and complaints, troubleshoot and resolve beneficiary problems, and provide systemic data and information about what’s working in a program as well as what can be improved.
The development of an ombudsman program—like that announced by CMS—featured prominently in Medicare Rights’ transition recommendations to President Trump and his team. As such, we strongly urge incoming leadership at CMS to follow through on this important commitment and to establish this program.