• What Next for CMS? Maintaining Excellence While Reducing Cost and Red Tape

    “Even though we undeniably have among the world’s best health care systems, that doesn’t mean—as you’re well aware—that it is without problems,” said Seema Verma, MPH, as she delivered the keynote speech during the AAO 2017 Opening Session on Sunday. “Our challenge is how we sustain this level of excellence as costs are growing.”

    New priorities for CMS. Ms. Verma, who was sworn in as head of the Centers for Medicare & Medicaid Services (CMS) in March, outlined 5 interrelated issues that she has prioritized.

    1. Easing the transition from volume based- to quality based-reimbursement. Under the Medicare Access and CHIP Reauthorization Act (MACRA), most ophthalmologists will participate in the Merit-Based Incentive Payment System (MIPS), which involves extensive—many would say excessive—reporting requirements.

    “We are taking a hard look at MACRA,” said Ms. Verma. “What we ultimately need is a system that can work for all providers across the country—urban, rural, small, and large—so the transition to MACRA doesn’t push providers out of the system and result in fewer patient choices.” Ms. Verma described 2 new CMS initiatives—Meaningful Measures and Patients Over Paperwork—that, along with a shift in focus for one of its sub-agencies, are intended to reduce the regulatory burden.

    2. The Meaningful Measures initiative. Launched last month, the Meaningful Measures initiative is tasked with reviewing and revising quality measures across all CMS programs, including MIPS. The goal: “Ensure that measure sets are streamlined, outcomes based, and meaningful to doctors and patients,” said Ms. Verma. “Until we get to a smaller set of more impactful measures that assess outcomes rather than processes, the burden associated with reporting measures will run the risk of outweighing their intended purpose.”

    The IRIS Registry has a role. Ms. Verma emphasized that she wanted physicians to take the lead in defining what the right quality measures are. “One bright spot is the American Academy of Ophthalmology’s registry, IRIS.” Not only does this feature Academy-developed quality measures, but “with 75% of all ophthalmologists participating, this provides the profession with true ‘big data’ that will benefit patient care.”

    3. The Patients Over Paperwork initiative. “The array of regulations that govern health care is overwhelming,” said Ms. Verma. CMS intends to address this with its Patients Over Paperwork initiative, which it announced last month. The plan: Review all CMS regulations, and for each one ask:

    • What’s the purpose?
    • Is it required by Congress?
    • Does it make sense?
    • Does it help us prevent fraud and abuse?
    • Does it meaningfully impact patient care and safety or improve outcomes?

    “When regulations no longer advance the goal of putting patients first, we must improve or eliminate them,” said Ms. Verma.

    4. Rebooting CMMI. The Center for Medicare and Medicaid Innovation (CMMI) focuses on testing different payment models, including Advanced Alternative Payment Models that would allow physicians to opt out of MACRA’s MIPS regulations. However, currently there are hardly any Advanced APM models for specialists, and not a single one for ophthalmology, said Ms. Verma, who seeks to change that. “We’re leading the Center for Medicare and Medicaid Innovation, or CMMI, in a new direction … that will promote flexibility and patient engagement,” she said. “We recently issued a Request for Information to collect ideas on the best path forward for the Innovation Center. We’re moving away from the idea that those in Washington can engineer a more efficient health care system.”

    5. Tackling the rising cost of prescription drugs. Rising from $87 billion in 2011 to $142 billion in 2015, “spending on prescription drugs has been growing more quickly than spending on any other area of Medicare,” said Ms. Verma, who outlined some plans to address that trend.

    Increasing competition. “We’re identifying opportunities to increase competition in Medicare Part B and Part D, as well as in the Medicaid program, to help market forces lower drug costs,” she said. “We know that many Part B drugs are biologics, so we’re making it a priority to encourage the development of lower-cost biosimilars. CMS recently announced a policy whereby biosimilars would get their own payment code, to encourage manufacturers to invest in biosimilars and increase competition.”

    Value-based payment for high-cost drugs. Ms. Verma said that CMS wants to work with stakeholders in developing arrangements “in which payment for a drug may, for example, vary based on the clinical outcomes achieved.”

    In conclusion, Ms. Verma said that across all of CMS’ efforts, “we know that we can’t do it alone. We need your input and ideas; we need you to work with us; we need you to challenge us.”—Chris McDonagh

    IRIS ® Registry is a trademark of the American Academy of Ophthalmology®.