HCFA and the National Partnership for Reinventing Government

The National Partnership for Reinventing Government (NPR) is a Clinton Administration initiative, under the leadership of Vice President Gore. NPR is designed to "reinvent" or "reengineer" the Federal bureaucracy to provide better service to the American public and more efficient use of taxpayer dollars.

HCFA was designated one of 32 Federal agencies that has a particularly direct impact on the American public. Originally called reinvention impact centers and later named high impact agencies, these agencies are expected to move toward being fully reengineered according to the NPR principles over the next several years.

As a high impact agency, HCFA is committed to the following specific goals:

Health Promotion

In partnership with others, HCFA works to improve health outcomes, including reducing the incidence of disease and the number of preventable deaths. As an NPR high impact agency, HCFA has committed to improve the well being and survival of Medicare and Medicaid beneficiaries through increased use of preventive services and other means. Specific performance targets have been established in the following areas:

• Increase the percentage of States (from 34 percent to 100 percent) conducting maternal AIDS information projects. These projects inform women of childbearing age of the importance of prenatal HIV testing and treatment if necessary. They also explain that these services are covered for Medicaid-eligible women.
  STATUS: As of February 2000, 44 States (88 percent), the District of Columbia and Puerto Rico were conducting maternal AIDS education projects.
• Increase from 59 percent (1995) to 80 percent the number of Medicare beneficiaries with end stage kidney disease receiving adequate hemodialysis.
  STATUS: In 1998, the percentage of Medicare beneficiaries with end stage kidney disease who were receiving adequate dialysis had risen to 74 percent. The 1999 data will be available in Fall 2000.
• Decrease the one-year mortality rate among Medicare beneficiaries hospitalized for a heart attack from 31 percent to 27 percent over 5 years. This is a decrease of 1 percentage point more than the national trend.
  STATUS: Progress data not yet available.
• Increase from 55 percent (1994) to 60 percent the number of Medicare beneficiaries aged 65 and older receiving an influenza vaccination (flu shot).
  STATUS: We met our target by achieving a 9 percent increase to 64 percent in 1998.
• Increase from 24.6 percent (1994) to 60 percent the number of Medicare beneficiaries age 65 and over receiving a vaccination for pneumonia. We projected that 50 percent of Medicare beneficiaries would be vaccinated by 2000 and 60 percent by 2002.
  STATUS: According to 1998 data, 56 percent of persons age 65 and older received a lifetime pneumococcal vaccination, surpassing our expectations for the year 2000.
• Increase from 55 percent (1994) to 60 percent the percentage of female Medicare beneficiaries age 65 years and older receiving a mammogram every two years.
  STATUS: We met our target by achieving an 8.8 percent increase to 63.8 percent in 1998.

Medicare Financial Integrity

HCFA is working to safeguard taxpayer dollars by improving the financial integrity of the Medicare program. Efforts include a stronger emphasis on reducing mistaken or inaccurate payments and preventing fraud and abuse. As a high impact agency, HCFA is specifically committed to the following goals:

• Achieve more than half of Medicare program integrity savings by reducing mistaken or inaccurate payments made on a prepayment basis. This means that more errors are detected and corrected before payment is made, eliminating the need to "pay and chase" overpaid amounts.
  STATUS: This goal has been achieved.
• Improve the efficiency of Medicare claim review by increasing the number of claims medically reviewed by 10 percent above original projections without increasing available funding. By more efficient review of Medicare claims to make sure that services being billed were medically necessary, we will detect and prevent more fraud, waste and abuse in the Medicare program.
  STATUS: Progress data not yet available.

HCFA had hoped to assess interventions to promote diabetic eye exams as a measure of diabetes disease management as one of its NPR goals. Due to limitations in data reporting for this measure, this has proved to be an infeasible goal for NPR in the calendar year 2000. HCFA remains committed to improving diabetes management for its beneficiaries. We work closely with our partners to promote quality diabetes care and are developing a performance measure to track this important issue.

For further information on HCFA's NPR goals, please contact Les Horneman at (410) 786-1044.