In an op-ed in the Wall Street Journal on Tuesday, Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), said the Trump Administration plans to lead the Center for Medicare and Medicaid Innovation “in a new direction” to give providers more flexibility with new payment models and to increase healthcare competition.
Congress created the Center for Medicare and Medicaid Innovation (CMMI) in 2010 to test new approaches and models to pay for and deliver health care. In the op-ed, titled “Medicare and Medicaid Need Innovation,” Verma, who is an appointee of President Donald Trump, referred to CMMI as a “powerful tool” for CMS to improve quality and reduce costs.
“On Wednesday, we are issuing a ‘request for information’ to collect ideas on the path forward. We will move away from the assumption that Washington can engineer a more efficient healthcare system from afar—that we should specify the processes healthcare provider are required to follow,” Verma wrote.
CMS’s request for information (RFI) can be found here, and the RFI online submission form to provide comments can be found here. The public also can submit comments by email to CMMI_NewDirection@cms.hhs.gov. CMS is accepting comments until November 20, 2017.
Verma said that CMS is analyzing all Innovation Center models “to determine what is working and should continue, and what isn’t and shouldn’t.” “The complexity of many of the current models might have encouraged consolidation within the health-care system, leading to fewer choices for patients. Strengthening Medicare and Medicaid will require health-care providers to compete for patients in a free and dynamic market, creating incentives to increase quality and reduce costs,” Verma wrote.
On the CMS Innovation Center website, CMS said the Innovation Center’s new direction will promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.
In particular, CMS says the Innovation Center is interested in testing models in the following eight focus areas—increased participation in Advanced Alternative Payment Models (APMs); consumer-directed care and market-based innovation models; physician specialty models; prescription drug models; Medicare Advantage (MA) innovation models; state-based and local innovation, including Medicaid-focused models; mental and behavioral health models; and program integrity.
CMMI, a division within CMS that has been acting as a facilitator of payment reform experimentation, has been a controversial department in the past few years. Both U.S. Department of Health and Human Services Secretary Tom Price, M.D., and Verma, as CMS Administrator, have voiced skepticism about some CMMI initiatives, including mandatory bundled payment programs. As previously reported by Healthcare Informatics, last fall, when Price still served as a Congressman from Georgia, he was one of 200 federal lawmakers who sent a letter to Andy Slavitt, acting administrator for CMS, calling out CMMI for overstepping its authority by proposing mandatory healthcare payment and service delivery models. In the letter, the legislators state that the proposals would negatively impact patients. What’s more, Verma, during her first Senate confirmation hearing back in February, also voiced similar thoughts about mandatory bundled payment programs.
Last month, as Healthcare Informatics reported, HHS issued a proposed rule that would cancel the mandatory bundled payment programs for heart attacks and bypass surgeries as well as expansion of the existing Comprehensive Care for Joint Replacement model (CJR) to include surgical treatments for hip and femur fractures. CMS officials said last month the proposed rule aims to provide “greater flexibility and choice for hospitals in orthopedic care for Medicare beneficiaries.”
CMS also proposed through that same rule to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin on January 1, 2018.
In the WSJ op-ed, Verma advocated for a shift away from a fee-for-service system that reimburses only on volume and move toward a system that holds providers accountable for outcomes and allows them to innovate. “Providers need the freedom to design and offer new approaches to delivering care. Our goal is to increase flexibility by providing more waivers from current requirements,” Verma wrote.
In addition, Verma said a system of market competition is the engine that has driven innovation in other industries. “No central planner gave Henry Ford a set of rules and instructions to manufacture the Model T. His ingenuity led to the product, and millions of consumers chose to buy it,” she wrote.
Verma also cited the need to empower patients with information as they seek value and quality when shopping for healthcare services. “Patients can define value better than the federal government can,” she wrote.
Verma also wrote, “Clinicians, patients, entrepreneurs, state officials and others are busy designing new and better ways to provide health care. There are a lot of great ideas, and we want to hear from people on the front lines. No government agency has all of the answers, especially in an industry as large and multifaceted as health care.”
Verma notes that it provides coverage to over 130 million Americans, more than a third of the population of the United States. The country’s elderly and most vulnerable citizens depend on these programs for access to care but both programs face fiscal crises, she wrote. “Medicare’s main trust fund is projected to run out in just eleven years, and Medicaid is the second largest budget item for states on average (behind K-12 education) and is growing rapidly. Improving quality and reducing costs are imperative,” Verma wrote.
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