- CMS Administrator Seema Verma says the Trump administration will continue to expand on its price transparency initiatives.
- An ongoing reassessment of value-based payment models may mean more mandatory models.
- Medicare is trying some moves to make telehealth waivers permanent but needs congressional help.
CMS will continue moving ahead with price transparency initiatives and is not concerned such efforts will increase healthcare prices, Administrator Seema Verma said this week.
The Trump administration has faced industry pushback, including lawsuits, on its various price transparency efforts. For instance, hospitals and national advocacy groups are appealing a June 23 federal district court decision to allow a January start of requirements for hospitals to post negotiated charges.
But Verma said such concerns will not sway the administration’s transparency push.
“We're on the side of patients, we're going to be fighting those court cases,” Verma said during a Q&A presented Wednesday as part of HFMA’s Digital Annual Conference. “We're excited that we won in our latest round, but we're going to continue to push on this.”
Medicare moved to build on the negotiated-charge requirement with recently issued additional requirements as part of the FY21 Inpatient Prospective Payment System (IPPS) proposed rule.
Verma also pushed back on concerns that such initiatives would increase prices when hospitals find out competitors receive larger health plan payments.
“At the end of the day, people have the right to know what they're being charged for,” Verma said. “And so, we may see some changes in prices. I think prices will go down.”
She cited accounts of hospitals lowering prices after they were required to publicly post them.
“We want to get to a point where providers are competing on the basis of price and quality, and that our patients are empowered as consumers,” Verma said. “We're not about special-interest groups; we're doing what's right for the American patient, and price transparency really fits into this.”
Verma shared her perspective during a Q&A with HFMA President and CEO Joe Fifer after being presented with HFMA’s Richard L. Clarke Board of Directors Award for her contributions to the financing of healthcare.
Mandatory payment models may be in store
Verma also expressed support for more mandatory models, for which some hospital executives say their organizations are not prepared.
“We've had a lot of voluntary models, and I'm not sure that works well because that sets up a selection bias, that only the providers that know they can do well are participating,” Verma said. “So, I think we have some very difficult decisions ahead for us around value-based care.”
Verma said the value transformation has been slow.
“We're at sort of an inflection point with value-based care,” Verma said. “We need to take a hard look at the models.”
She said analyses by the Center for Medicare and Medicaid Innovation have shown that “many of our models are not working well for the federal taxpayer, that we're seeing a lot of losses.”
She attributed the shortcomings to an earlier federal emphasis on encouraging provider participation in value-based payment. That approach dictated the design of the models, “as opposed to making sure that the taxpayer was getting the best deal.”
Some models have improved quality but haven’t lowered federal spending.
“That being said, we're not giving up on this because I don't think a fee-for-service model is going to be sustainable for our country over the long term,” Verma said. “And so I think the way to do this is when you are paying providers on a value-based system, that really encourages them to think about the type of innovative care that they need to deliver to increase quality and lower costs.”
She cited increased use of telemedicine as a value-oriented innovation because “it's faster, it's quicker, it's probably cheaper for [providers] to some degree.”
Telehealth expansion in the works
Verma said the Trump administration is committed to the expansion of telehealth that has occurred during the COVID-19 pandemic. Telehealth waivers were among more than 135 Medicare regulations waived by the administration to help providers address the pandemic. President Donald Trump recently issued an executive order to push for permanent expansion of telehealth, and CMS has been seeking to establish such expansions via recently issued Medicare provider payment rules.
Verma warned that new legislative authority will be needed to make some of those temporary waivers permanent.
“It will be up to Congress to allow for telehealth services to be provided outside of just a rural setting and to be able to allow our beneficiaries to do telehealth inside their homes,” Verma said.
Some commercial plans have followed Medicare’s temporary expansion of telehealth with their own payment policy changes because they see “that patients really appreciate having this option and providers like it as well.”
“And so hopefully we'll see more adoption, not only by Medicare but also our private insurers. Governors across the country are also working very hard to make this a permanent benefit in the Medicaid program,” Verma said.