Innovation and Disruption

April 30-May 4 Policy Watch: How Policymakers Aim to Support Healthcare Innovation

April 26, 2018 5:54 pm

Ahead of planned speeches next week by HHS Secretary Alex Azar and CMS Administrator Seema Verma, industry experts urged federal policy changes to spur healthcare delivery innovation.


April 26—Senior Trump administration officials are likely to tout their efforts to support innovations in healthcare delivery during presentations next week at a Washington, D.C., health policy event. Some of the areas they still need to address came up in Congress this week.

Alex Azar II, secretary of the U.S. Department of Health and Human Services (HHS), and Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), are scheduled to address the annual World Health Care Congress next week. They are likely to tout recently unveiled rule changes that aim to implement their leading policy priorities. For instance, one repeated priority of Azar’s is “transforming our healthcare system to a value-based system.”

Despite the recently proposed policy changes, other federal rules and laws continue to obstruct significant delivery reform, industry leaders told Congress this week.

Oliver Kharraz, MD, CEO of Zocdoc, testified to the House Ways and Means Committee’s Health Subcommittee that compliance with dated federal anti-kickback laws requires the company to charge a flat fee to all providers that participate in its online medical care scheduling service, instead of tying charges to the number or value of appointments that providers receive.

“That creates challenges, in particular for rural providers and small practices because they have to take on the entire economic risk of participating on the platform,” Kharraz said.

Also needed is a streamlining of Medicare rules around telehealth, Becki Hafner-Fogarty, MD, senior vice president, policy and strategy for Zipnosis, told the panel.

That need was underscored by the recent findingof the HHS Office of the Inspector General that 31 of 100 distant-site telehealth claims did not meet CMS requirements for payment. It estimated that CMS spent $3.7 million on those incorrect claims.

Complex CMS requirements around eligibility for telehealth payments include rural status, location in a health professional shortage area, or status as a Medicare Advantage accountable care organization (ACO).

“What they found was that 90 percent of those misbilled visits were purely honest mistakes because the doctor was a mile too close to a major metropolitan area or they weren’t rural enough; that was a major problem,” Hafner-Fogarty said. “The best thing you could do for telemedicine in my book is remove the originating-site restrictions.”

Sean Cavanaugh, chief administrative officer for Aledade and formerly an Obama administration health policy leader, told the panel that federal anti-kickback rule and limitations on telemedicine are “all artifacts of a fee-for-service system; where the incentive is to do too much, so how do we put guardrails around people doing too much.”

“If you can get health systems and physicians in a value-based model where they are actually accountable for the total costs of care, then most of these concerns should fall by the wayside because they have no incentive to overutilize care,” Cavanaugh said.

To make more physicians and hospitals accountable for the total cost of care, Cavanaugh said federal policy needs to push the majority of ACOs that are now in upside-only models into downside risk.

To reduce electronic health record information blocking, Cavanaugh hailed a policy that was included in the Inpatient Prospective Payment System proposed rule released this week. That policy would make data sharing between providers a condition of participation in Medicare.

“You may think this is valuable, proprietary data, but [not sharing] it is hurtful to the beneficiary,” Cavanaugh said. “It’s when you step back and think of these as business models, that’s where we get into trouble.”

Monday, April 30

15th Annual World Health Care Congress in Washington, D.C. (through May 2). Learn more.

Advisory Board webinar titled “Develop a Comprehensive Opioid Response Strategy.” Learn more.

Deadline for clinicians in the Merit-based Incentive Payment System (MIPS) to apply to participate in a CMS study on the burdens associated with reporting MIPS quality measures in 2018. Learn more.

Social Determinants of Health Symposium hosted by the Johns Hopkins Urban Health Institute. Learn more.

Health 2.0 and HIMSS host the Dev4Health Conference (through May 1). Learn more.

Tuesday, May 1

CMS webcast on learning to use the Medicare Cost Report e-Filing system. Learn more and register.

Webinar by America’s Physician Group titled “A Deep Dive on the Medicare Advantage Final Rate Notice and Call Letter.” Learn more.

Fourth-quarter 2017 Population and Sampling data submission deadline for hospitals participating in the Hospital Inpatient Quality Reporting Program. Learn more.

CMS webinar on the Quality Payment Program Year 2. Register.

SAMHSA webinar titled “Engagement via a Crisis or Pre-crisis Tool within a Wellness Recovery Action Plan (WRAP).” Learn more.

National Quality Forum workshop titled “Driving Patient Safety and Quality through Opioid Stewardship.” Learn more.

Wednesday, May 2

CMS webinar titled “Quality Measures: How They Are Used and How You Can Be Involved.” Learn more.

Meeting and webcast of the National Academy of Medicine titled “The Action Collaborative on Clinician Well-Being and Resilience. Learn more.

Building a Healthier Future Summit hosted by the Partnership for a Healthier America (through May 4). Learn more.

Thursday, May 3

Deadline to vote in HFMA’s Virtual Pitch Contest to determine which companies will be featured in the Innovation Hub at the 2018 Annual Conference. Learn more.

End of the public comment period for CMS’s cross-setting post-acute care quality measures on the transfer of health information and care preferences as part of implementation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Learn more.

Workshop by the National Institutes of Health titled “Screening and Referral for the Social Determinants of Health: Innovative Health Care Applications and Future Directions.” Learn more.


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