Perspectives on Medicare

Seema Verma, MPH, Administrator, for the Centers for Medicare and Medicaid Services, presented her ideas and thoughts at the Alliance for Health Policy www.allhealthpolicy.org APCO Worldwide Brazda Breakfast media event. She emphasized how Medicare impacts healthcare for millions of beneficiaries across the delivery system.

Innovation is key to CMS goals. A Request for Information (RFI) was released last fall seeking a new direction for the CMS Innovation Center https://innovation.com.gov. CMS is sharing the feedback from the RFI which suggest ways to decrease unnecessary costs and improve patient choice and transparency for the benefit of the patient.

She mentioned, “In June 2018, CMS issued another Request for Information seeking ideas and input from the public on how to address any undue impact and burden of the physician self-referral law also known as the “Stark Law”.

“We are looking for information and bold ideas on how to change the existing regulations to reduce provider burden”, said Administrator Seema Verma, “Dealing with the burden of the physician self-referral law is one of our top priorities as we move towards an healthcare system that pays for value rather than volume.”

The Administrator wants to unleash the power of patients and involve them actively in their care. This means that the right information needs to get to the right patient and their provider. She mentioned “MyHealthEData” which is based on putting patients first by making more data available, and then taking an API approach to exchanging data in a secure and private manner with CMS partners.

In addition, CMS has more information on available data at https://www.resdac.org. This site includes information on the “CMS Chronic Conditions Data Warehouse” (CCW), a research database designed to make Medicare, Medicaid Assessments and Part D Prescription Drug Event data more readily available.

Just recently, CMS proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than the volume of care.  Specifically, CMS proposed changes to improve access to solutions via remote patient monitoring technology and to update the payment model for home health care.

These changes are expected to help the adoption of emerging technologies by home health agencies and will result in more effective care planning as data is shared among patients, caregivers, and providers.

The Administrator also addressed drug pricing issues. She pointed out that due to the rapid pace of innovation in medicine, treatments and cures are available today that doctors couldn’t have imagined a generation ago.

She reported, “Medicare spending on prescription drugs is growing more rapidly than spending in any other area. Also, spending on prescriptions is on the rise in Medicaid with expensive new therapies putting a strain on state budgets.” CMS wants to test new models for prescription drug payment in both Medicare and State Medicaid programs that will produce lower costs and also align payment with value.

A panel of industry leaders and stakeholders added their thoughts to Administrator Seema Verma’s remarks. Panelists included David Certner, J.D Legislative Counsel and Legislative Policy Director, Government Affairs, AARP, Richard Deem Senior Vice President, Advocacy AMA, Mark Hamelburg, Senior VP, Federal Programs, America’s Health Insurance Plans, and Joanna Hiatt Kim, VP, Payment Policy, American Hospital Association.

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