Lack of performance measures hampers Medicare

The Center for Medicare and Medicaid Services (CMS) lacks a performance-based culture critical to making improvements to the program, according to a recent General Accounting Office report. Few senior CMS managers reported being held accountable for achieving results, according to the report, "Medicare Management: CMS Faces Challenges to Sustain Progress and Address Weaknesses," (GAO-01-817). In a May survey of federal managers, GAO found that CMS ranked second-lowest in terms of managerial accountability in four areas: output, efficiency, quality and outcome measures. "Measuring performance in assessing a program's efforts to achieve its goals is essential to fostering a performance-based culture and managing for results," GAO said. In recent attempts to improve program management, CMS Deputy Administrator Ruben King-Shaw was tapped as chief operating officer. He's responsible for day-to-day management and is based in the agency's Baltimore headquarters. In previous administrations, the deputy was based in Washington. Agency officials also launched an ambitious plan to realign some agency functions. The goal is to make CMS more responsive to beneficiaries and health care officials. While critical of the management culture, GAO was quick to point out that CMS is often pulled in several different directions and that its administrative budget has remained flat while program responsibilities have grown. In fiscal 2000, Medicare's operating budget accounted for less than 2 percent of program outlays. Overall, CMS is expected to pay out nearly $400 billion this year in benefits to the poor and elderly. Meanwhile, its administrative budget barely tops $2 billion. Limited resources have hindered CMS' ability to improve its work in such areas as improving nursing home quality, contractor oversight and its claims administration. GAO is not the first to draw attention to the agency's stretched resources. Last May, four former agency chiefs urged Congress to increase the agency's administrative budget. Congressional staff from both the House and Senate agreed with GAO that CMS needs better management. Policy debates about Medicare reform, such as adding a prescription drug benefit, make it imperative that the agency improves its management performance. Without it, Medicare reforms could overwhelm the agency, they said.
Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
Close [ x ] More from GovExec

Thank you for subscribing to newsletters from
We think these reports might interest you:

  • Sponsored by G Suite

    Cross-Agency Teamwork, Anytime and Anywhere

    Dan McCrae, director of IT service delivery division, National Oceanic and Atmospheric Administration (NOAA)

  • Data-Centric Security vs. Database-Level Security

    Database-level encryption had its origins in the 1990s and early 2000s in response to very basic risks which largely revolved around the theft of servers, backup tapes and other physical-layer assets. As noted in Verizon’s 2014, Data Breach Investigations Report (DBIR)1, threats today are far more advanced and dangerous.

  • Federal IT Applications: Assessing Government's Core Drivers

    In order to better understand the current state of external and internal-facing agency workplace applications, Government Business Council (GBC) and Riverbed undertook an in-depth research study of federal employees. Overall, survey findings indicate that federal IT applications still face a gamut of challenges with regard to quality, reliability, and performance management.

  • PIV- I And Multifactor Authentication: The Best Defense for Federal Government Contractors

    This white paper explores NIST SP 800-171 and why compliance is critical to federal government contractors, especially those that work with the Department of Defense, as well as how leveraging PIV-I credentialing with multifactor authentication can be used as a defense against cyberattacks

  • Toward A More Innovative Government

    This research study aims to understand how state and local leaders regard their agency’s innovation efforts and what they are doing to overcome the challenges they face in successfully implementing these efforts.

  • From Volume to Value: UK’s NHS Digital Provides U.S. Healthcare Agencies A Roadmap For Value-Based Payment Models

    The U.S. healthcare industry is rapidly moving away from traditional fee-for-service models and towards value-based purchasing that reimburses physicians for quality of care in place of frequency of care.

  • GBC Flash Poll: Is Your Agency Safe?

    Federal leaders weigh in on the state of information security


When you download a report, your information may be shared with the underwriters of that document.