Every CMS administrator has to navigate tricky political terrain. Seema Verma is no different. Since being confirmed in March 2017, she's had her share of controversy, including questions about the agency's use of federal dollars to boost her image, efforts to expand Medicaid work requirements, and pushing rules forcing providers and payers to be more transparent about their pricing.
As she prepares to leave office next week, Verma fervently defends the Trump administration's efforts to adopt policies that will "reverberate" across the industry. She talked with Modern Healthcare's rules and regulations reporter Michael Brady about everything from needing to revamp what the Center for Medicare and Medicaid Innovation does to axing the Medicaid fiscal accountability regulation. The following is an edited transcript.
Most signficant changes to Medicare
Verma: We used our outsized role in the Medicare program to overhaul long-standing policies that were thwarting competition and were encouraging the development of healthcare monopolies that were driving up costs. So essentially the changes that we made in Medicare are not just about Medicare itself, but will reverberate into the (broader) healthcare system.
A few things that we did around monopolies, I think, are very important. Just recently, we finalized policy to basically have more of a level playing field when it comes to surgery centers and hospitals. The changes that we made to 340B—decreasing the reimbursement that 340B providers were getting under the Medicare program because they were getting discounts from the government and yet they were being reimbursed for the drugs at a very high rate. That put them in a position where they can buy out other physician practices. (That rule) didn't save any money for the federal government, it went right back into the program, but it was about addressing monopolies.
Site-neutral payments was also a significant change that we've made. We've taken the concepts of free-market competition and try to infuse them throughout the healthcare system.
Future of Medicare Advantage
Verma: The changes … we made to the Medicare Advantage program … have delivered better results to people using Medicare Advantage—lower historic premiums, 34% lower. That is a 14-year low.
You're seeing a record number of people flock to the Medicare Advantage program. And I think it's because of the changes that we've made. People are getting better value. You're getting better benefits. You're getting lower costs.
Rethinking CMMI
Verma: We took a really long, hard, comprehensive look at CMMI and its operations. One of the very first things that we did in 2017 is put out a request for information about what types of models that needed to be developed. So I think it's been twofold, not only just putting out models, but we've also taken a look at CMMI's operations. There is only so much capacity that CMMI has to operate models and it's not endless. What we've done is we've looked at every single model. We've evaluated them to see how are they operating. Are they improving quality? Are they lowering costs? And you've seen that we've eliminated a lot of models. You've seen that we have tried to make changes to a number of models as well increase their performance, to make them work better. The new models that we've put out have been very strategically chosen. These are ones that we think are going to have the largest impact on the healthcare system.
We have to keep our foot on the gas when it comes to working toward value-based care. This is something that has bipartisan support.
Unfinished business
Verma: Unfortunately, I think the pandemic deterred our efforts and most states this year have been focused more so on the pandemic than reforming their Medicaid system or the individual market. The other area that I think requires more work … is the reform of our elder-care system and ensuring quality and safety in nursing homes and making sure that older Americans have more choices about where and how they receive their care as they grow older.
Withdrawing MFAR
Verma: The goals of that rule were well-intended. There's been a lot of abuses in the Medicaid program that undermine beneficiary care. We want to make sure that every dollar is going to Medicaid beneficiaries and that the dollars are being used in an appropriate way. So I think the goals were laudable, but at the end of the day, I've been very clear that we're always going to listen to our stakeholders. And I think I evaluated the comments personally, and recognize that the rule may have had some unintended consequences.
And so we didn't move forward with that because that was never the intent. We want to make sure that beneficiaries have the care they need and that the safety-net system is appropriately funded. There were issues with the rule and that it needed more work. That being said, we were very pleased that Congress included in this last (COVID-19 relief) law that was passed … some of the requirements that we had in MFAR around transparency about the source of state matching funds. So I think that was a victory.
Post-CMS plans
Verma: I've been telling everybody today, trophy wife. That is what I'm doing next. I'm going to be the best trophy wife that I can be.
I've been so focused on the job that I haven't really thought about what the next steps are. I mean, this job is so demanding. It requires 120%. You're thinking about it. You dream about it. And you work on it really every minute of the day, every weekend. I haven't thought about what comes next, but I want to continue my work to make sure that Americans have access to affordable care, affordable high-quality care.
