CMS Medicare Payment Systems Modernization (MPSM)
Investment ID: 009-000430646
Overview
Program Title
CMS Medicare Payment Systems Modernization (MPSM)
Description
As the needs of the business and user community change and evolve, the need to modernize the FFS Shared Systems has become essential to improve the agility and sustainability of the Medicare Payment Systems.
All work completed on this effort must meet one or more of the following four prioritized goals.
- Sustainability - the system, resources, and processes can maintain their current levels of service during modernization efforts.
- Agility - the system needs to evolve, sustainability, at the same speed as the business.
- Integration - systems involved in making payments, and other CMS business functions, need the option to use modern technology to interact with the current state of the shared systems.
- Usability - users interacting with the shared systems need to easily identify and extract the exact data they need, when they need it.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable
Investment Detail
Our current payment systems include three different processing systems (FISS, MCS, and VMS) and another shared system (CWF) used to validate eligibility and provide cross-benefit utilization information and history. These systems were based on processing systems used by commercial insurers when Medicare began. The primary programming languages are Assembler and Cobol, which are no longer industry standard. That means that the workforce that has this programming experience and knowledge is aging out and the skill set is virtually non-existent in potential new hires. Further, the systems were architected based on traditional fee-for-service payments, segregated by provider type, and are complex. This architecture does not easily or efficiently support innovation in payment for healthcare services (value-based purchasing) in order to lower healthcare costs while increasing quality of care. The expected benefits of and return on the MPSM investment are primarily qualitative in nature. The modernization investment is both an incremental and iterative effort to re-architect and re-engineer the systems using modern, more nimble programming languages and infrastructure (such as Cloud hosting). Over time, this investment will mitigate the risk of a dwindling workforce with old-language programming skills, and foster innovation in payment methodologies, allowing CMS to test, adjust, and expand those methodologies quickly. As we embark on modernizing our systems, it is absolutely critical that we maintain the integrity and function of the systems so that they may continue to support Medicare as the nation's fasted healthcare insurance payer while in the midst of change. An incremental and iterative approach provides the best mitigation against breaking the systems along the way.