By Susan Morse
President Trump on Thursday railed against the Democrat’s Medicare for All plan at a Florida rally where he signed an executive order to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
“The proposed Medicare for All Act of 2019, as introduced in the Senate would destroy our current Medicare program…,” Trump said in the order. “‘Medicare for All’ would take away the choices currently available within Medicare and centralize even more power in Washington, harming seniors and other Medicare beneficiaries.”
Ways and Means Committee Chairman Richard E. Neal, a Democrat responded, “As expected, this executive order does little to help the majority of Medicare beneficiaries. Republicans do not want to protect Medicare – President Trump’s latest budget proposal slashes the program by $575 billion, and congressional members of the GOP regularly call for cuts to the benefit.”
Within 180 days of the order, the Secretary of the Department of Health and Human Services is to identify approaches to modify Medicare fee for service payments to more closely reflect the prices paid for services in Medicare Advantage plans and the commercial insurance market, to inject market pricing into Medicare FFS reimbursement.
The executive order will allow Medicare Advantage plans to develop more coverage choices for seniors and people with disabilities, said Matt Eyles, president and CEO of America’s Health Insurance Plans. Medicare Advantage outperforms traditional Medicare on 16 out of 16 different clinical quality measures, he said and seniors covered by MA plans have a higher satisfaction rate with their plans than traditional Medicare.
THE IMPACT: WHAT THE ORDER DOES
Within 180 days, the Secretary is to recommend approaches to transition to true market-based pricing in the fee for service Medicare program, including shared savings and competitive bidding and the use of MA-negotiated rates to set FFS Medicare rates.
Within one year, the Secretary is to use Medicare claims data to give providers additional information regarding practice patterns for services that may pose undue risks to patients, and to inform them of practice patterns that are outliers or that are outside recommended standards of care.
Other actions, many within one year of the date of the order, include:
- Enabling the Medicare program to provide beneficiaries with more diverse and affordable plan choices;
- Reducing barriers to obtaining Medicare Medical Savings Accounts and promote innovations in supplemental benefits and telehealth services, including a payment model that adjusts supplemental MA benefits to allow Medicare beneficiaries to share more directly in the savings from the program, including through cash or monetary rebates;
- Improving access to providers and plans by adjusting network adequacy requirements for MA plans to account for the competitiveness of the health market and enhanced access to health outcomes made possible through telehealth services or other innovative technologies;
- Making reforms to enable providers to spend more time with patients by proposing a regulation that would eliminate burdensome regulatory billing requirements, and propose a regulation that would ensure appropriate reimbursement by Medicare for time spent with patients;
- Encouraging innovation for patients by streamlining the approval, coverage, and coding process so that innovative products are brought to market faster, and so that such products, including breakthrough medical devices and advances in telehealth services and similar technologies, are appropriately reimbursed and widely available;
- Adopting regulations and guidance that minimize and eliminate the time and steps between approval by the Food and Drug Administration and coverage decisions by the Centers for Medicare and Medicaid Services;
- Clarifying the application of coverage standards, including the evidence standards CMS uses in applying its reasonable-and-necessary standard, the standards for deciding appeals of coverage decisions, and the prioritization and timeline for each National Coverage Determination process in light of changes made to local coverage determination processes;
- Modifying the Value-Based Insurance Design payment model to remove any disincentives for MA plans to cover items and services that make use of new technologies that are not covered by FFS Medicare when those items and services can save money and improve the quality of care.
- Rewarding care through site neutrality and proposing regulatory changes to reduce the burden on providers and eliminate regulations that create inefficiencies or otherwise undermine patient outcomes.
ON THE RECORD
CMS Administrator Seema Verma, “We look forward to swiftly implementing these bold and comprehensive policies, which build on the steps we have already taken, to increase choices, encourage medical innovation, empower patients, and eliminate waste, fraud and abuse to protect seniors and taxpayers.”
“America’s seniors are overwhelmingly satisfied with the care they receive through traditional Medicare and Medicare Advantage, and the President is continuing to take action to strengthen and improve these programs,” said Health and Human Services Secretary Alex Azar. “These kinds of improvements, rather than a total government takeover of the healthcare system, are the path to our ultimate goal: better health for all Americans.”
Premier Senior Vice President of Public Affairs Blair Childs said, “We call on the administration to expand on its executive order to explicitly include providing better incentives and more information on the new proposed alternative payment models, speeding provider access to claims and EHR data through open application programming interfaces, removing the regulatory impediments, such as Stark and Anti-kickback laws, to clinical integration, and incenting Medicare Advantage plans to partner with and develop risk-based arrangements with providers.”
“We applaud the President for proposing to strengthen the value of Medicare Advantage,” said AHIP’s Matt Eyles. “We support the executive order’s direction to improve seniors’ access to care in Medicare Advantage, including expanded use of telehealth, greater flexibility in designing high-quality provider networks, and encouraged innovation in value-based care. We also support additional flexibility for MA plans to offer supplemental benefits that seniors want – which will be highly-valued and attractive new benefit offerings for 2020.”