In the wake of soaring Medicare spending, HHS Secretary Alex Azar told a group of hospital executives that the Trump administration is committed to transitioning away from a fee-for service system.
"There is no turning back to an unsustainable system that pays for procedures rather than value," Azar said at a Federation of American Hospital's policy conference Monday. "This administration and this president are not interested in incremental steps. We are unafraid of disrupting existing arrangements simply because they're backed by powerful special interests."
Policy insiders were pleased with Azar's remarks as there had been concerns that the Trump administration was moving away from voluntary pay models following the cancellation and scaling back of several such initiatives last year.
"His remarks, given at the FAH Conference, are likely the department's most important statement on health care issued during this administration," said Michael Leavitt, a former Republican governor of Utah and HHS secretary under George W. Bush.
"I highly encourage health care leaders to listen intently to his full remarks. The transition value is moving forward; if you aren't already preparing for it, it is time to get on-board."
Azar's remarks come a few weeks after he had indicated at his confirmation hearings that he would support mandatory pay models. That's a change of course from his predecessor Tom Price, who believed providers should choose to participate in such experiments.During his remarks Azar stopped short of calling for mandatory pay models, but cited accountable care organizations, a voluntary value pay initiative, as yielding disappointing results.
"Results for the early stages of federal efforts to encourage accountable care organizations have been, to be honest, underwhelming," Azar said.
Last year, HHS' Office of Inspector General said MSSP ACOs reduced Medicare spending by about $1 billion in three years. Every year, Medicare spends more than $500 billion.
"We want to look at bold measures that will fundamentally reorient how Medicare and Medicaid pay for care and create a true competitive playing field where value is rewarded handsomely."
Azar's speech also drew interest as he hinted that his agency is doing more to ensure that patients can access their medical records when they need to and to share them with new providers they are starting to see.He announced that CMS Administrator Seema Verma and Jared Kushner of the White House Office of American Innovation would be making announcements regarding actions this administration will be taking to put patients in control of their own health data.
"Too often, doctors and hospitals have been resistant to giving up control of records, and make patients jump through hoops to get something as basic as an image of a CT scan," Azar said. "The healthcare consumer, not the provider, ought to be in charge of this information."
Some health technology insiders were confused by the remarks as legally patients can call and request their information if they are seeing a new doctor, even if they owe the old provider money, according to Kenneth Dort, a partner and privacy lawyer with Drinker Biddle & Reith in Chicago.However, there are areas in need of improvement. For instance, if a patient is unconscious and has little or no information on them there isn't a central repository of patient information where a doctor can find info they may need.
More work also needs to be done to make it easier to get data from one electronic medical record vendor and make it usable by another, according to Daniel Shay, attorney with Alice Gosfield & Associates in Philadelphia. It's unclear if either of these issues or something else altogether, will be addressed during Tuesday's announcement.
"It seems like an announcement about an upcoming announcement," Shay said of Azar's speech. "It may not even be the trailer for the movie, just a teaser."
