‘Culture Wars’ at CMS?

By Gregg A. Masters, MPH

The first declaratory though public announcement on when industry stakeholders could expect the highly anticipated guidance via the first round of a notice of proposed rule making (NPRM) process, was Q4 2010. Subsequent updates has suggested first a January, and now February, release date.

Some of the skeptics referring to CMS as a ‘black box’ say, Q1 2011 is the likely revised ‘expectations management’ benchmark, though I find that hard to digest given the January 2, 2012 ‘go live’ date.

But as is always the case, culture will have it’s say. As has been reported elsewhere, a case can be made that CMS is embroiled in an ‘internecine warfare’ of sorts, as to who is driving the innovation bus, let alone the ‘routine program’ implementation of the Patient Protection and Affordable Care Act, specifically with respect to ACO’s and the ‘low brainer’ iteration of the Medicare Shared Savings Program (MSSP).

The roots of CMS Medicare culture are to be found in the Part A and B staff silos, their institutional currency, but more important ‘line standing’ in operational decisions, vs. the nascent Center for Medicare and Medicaid Innovation (CMMI) let alone the ‘Johnny come lately’ Medicare Advantage aka “Managed Care’ staff.

From my reading of the ‘tea leaves’ the traditional Medicare staffers are ‘hunkered down’ for the fight and may be a partial explanation for the delay we are witnessing?

Anyone with additional or more current insights?


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