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Transcript for audio podcast: OIG Outlook 2014: Deputy IG for Evaluation and Inspections, Stuart Wright

From the Office of Inspector General of Department of Health and Human Services

[Roberta Baskin] Now a look at the work of the Office of Evaluation and Inspections, led by Deputy Inspector General Stuart Wright. Stuart's in charge of what we think of as the academic branch of OIG. Medicare and Medicaid command the majority of OEI's time, but what are some other arenas that you do evaluations for?

[Stuart Wright] Well, the majority of our work does pertain to Medicare and Medicaid. We do evaluation work across the department's program. So we also look at FDA, NIH and CDC.

[Roberta Baskin] Now, how do you choose the types of evaluations that you're going to tackle in 2014?

[Stuart Wright] We select our evaluations based on risk in accordance with organizational goals. We look at areas with fraud, waste and abuse in mind, and we also look to see whether departmental programs are working as they're intended to work.

[Roberta Baskin] Well, out of the huge bandwidth that you have, what are three areas that you're going to focus on for evaluations in the year ahead?

[Stuart Wright] Three areas that we're going to focus on would be quality of care, accuracy of payments and access to care.

[Roberta Baskin] The work that you've done on adverse events and patient harm has gotten a lot of attention. Just briefly share some of those findings.

[Stuart Wright] Sure. We previously reported on the extent to which adverse events -- these are instances where patient harm actually occurs in the hospital setting. We analyzed Medicare beneficiaries to determine how frequently how that occurred and found that more than 13 percent of beneficiaries actually had an adverse event occur to them in the hospital.

[Roberta Baskin] And in the year ahead, you're going to be expanding that work into nursing homes. Give us some headlines on that.

[Stuart Wright] Sure. We'll be expanding that work to look at adverse events in skilled nursing facilities. In addition, we will assess the extent to which those events could have been preventable, and we will assess the Medicare costs associated with those adverse events.

[Roberta Baskin] Your Medicare evaluation and management work looks at very small dollars, like a hundred dollars, but it really adds up. What's the significance?

[Stuart Wright] You're correct, Roberta. While evaluation and management's codes -- these are the services that Medicare pays for doctor visits -- are small, they add up to approximately $33 billion a year in payments.

[Roberta Baskin] Thirty-three billion a year.

[Stuart Wright] Correct. We previously reported on the trends in Medicare payments and the extent to which physicians consistently billed at the highest code levels. We will now be reporting on the extent to which those codes are accurate in terms of Medicare payments and the extent to which Medicare paid for services that they shouldn't have been paying.

[Roberta Baskin] And finally, your Medicaid managed care access work, what kinds of assessments will you be doing with the states?

[Stuart Wright] During the upcoming year, we will be assessing the extent to which states place requirements on their Medicaid managed care networks in terms of ensuring that beneficiaries have access. In addition to looking at what states have, in terms of requirements and the oversight that they perform with respect to those requirements, we will actually be assessing the extent to which beneficiaries can schedule appointments with providers.

[Roberta Baskin] And so, what's the impact of that on patients?

[Stuart Wright] Obviously, there's a real quality of care impact. Beneficiaries need to be able to schedule appointments timely, when they need care.

[Roberta Baskin] Thanks, Stuart, for sharing these insights on what you can anticipate in 2014 for OIG's upcoming evaluations and inspections.

[Stuart Wright] Thank you, Roberta.


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