In a brief but pointed address on Monday afternoon to attendees at the World Health Care Congress, being held at the Marriott Wardman Park in Washington, D.C., Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services (CMS), reiterated key policy positions of the Trump administration around healthcare, and asked healthcare industry leaders to support the administration’s goals around regulatory reform and healthcare consumer empowerment.
Speaking for about 18 minutes, Administrator Verma noted that “One of the things I enjoy about being the CMS administrator is that I have a unique vantage point on U.S. healthcare. We are the nation’s largest insurer. Our footprint on the US healthcare system is so significant that everything we do has an impact on every American, whether they are a CMS beneficiary or not. That solemn responsibility is constantly on my mind,” she said. “We have the responsibility not only to deliver high-quality services to our recipients,” but also, knowing that anything that CMS focuses on will influence the healthcare industry at large, to do whatever is possible to compel improvements in the broader healthcare system as well, through the agency’s overall influence.
Verma made it clear that she believes that the U.S. healthcare spending trajectory is unsustainable, with spending growth that outstrips general price inflation something she considers unacceptable. “A looming healthcare crisis on the horizon” around cost, Verma said. “When I say crisis, I’m not engaging in hyperbole. Spending growth higher than overall economy” continues apace, she noted. “By 2026, we will be spending of every five dollars on healthcare. That means healthcare spending will crowd out other priorities,” she noted, such as infrastructure, defense and education. “And for every American citizen, it means that more and more dollars will go to higher premiums, deductibles, and copays. The bottom line is that our system is unsustainable; and there’s no easy solution.”
What’s more, Verma said, healthcare spending inflation is growing at the same time that outcomes are not improving relative to those of other countries. “A recent Harvard study compared healthcare spending in the U.S. with that of 10 other nations,” she said. “The U.S. ranked poorly in infant mortality and treating chronic conditions, and on average, we have shorter lifespans. We spend more money, and get less from it.”
Given the lack of demonstrated value for spending, Verma says that action is necessary, adding that “President Trump agrees. To that end, he has encouraged us to take bold action to increase quality, improve outcomes, and lower cost. Those are not new concepts,” of course, she said, but the key will be to increase value in healthcare, and use the power of CMS payment to force a march towards that value.
And, in that fight, “Some progress has been made,” Verma said. “But if we’re going to take the final steps, we must activate the most powerful force in our healthcare system for creating value: the patient. We must do better for them, and for that, patients need to be empowered, particularly through full access to and ownership of their electronic patient records. With regard to that, “Last month, we launched the MyHealthEData Initiative, to empower patients by giving them control of their health records,” and with that initiative, “we made it crystal clear that the days of keeping patient records [from patients] must end.” Further, she said, “We have proposed payment consequences for hospitals that don’t give patients access, and have asked that providing patients with access to their records be a requirement for participating in Medicare.” And, she added, “We will take very action necessary” to make sure that that goal is fulfilled. Among the steps she touted was the recent release of “Blue Button 2.0, a developer-friendly, standards-based API [application programming interface], which will allow a majority of beneficiaries connect their claims data to payers. We are also working to advance price transparency,” she added. “In virtually every sector of the economy, you are aware of the cost of services before you accept them. Patients need to know” the costs and value of healthcare services received, she said. What’s more, she said, “We are proposing a requirement that hospitals post their charges online. We’re just getting started, and are asking for input” from provider leaders nationwide.
“Another barrier to care is overly burdensome federal regulations. CMS produces over 11,000 regulations a year,” Verma stated. “Many more are redundant, unnecessary, and actually have a negative impact” on quality or value, “costing our healthcare system $39 billion a year.”
And she emphasized a consumer-driven, market-driven frame for how she views the regulatory sphere. “We believe that Americans can define quality better for themselves. We don’t want to decrease competition, or choice, for beneficiaries,” she said.
Meanwhile, she said, “We are also looking to meet the needs of the 11 million Americans who have purchased their insurance on the health insurance exchanges, and to help the 28 million Americans still without insurance.”
Addressing charges around the ACA
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