Modern Healthcare reporter Shelby Livingston caught up with CMS Administrator Seema Verma in Nashville, Tenn., on Friday to talk about COVID-19 hospital relief funds, CMS' role in distributing a potential coronavirus vaccine, and how the agency is looking at the future of telehealth, kidney disease treatment, and the role of the pharmacist in healthcare. Below is an edited transcript.
Modern Healthcare: When are you going to recoup the Medicare accelerated payments? (Federal law requires that HHS claw back the $100 billion in Medicare Accelerated and Advance Payment Program funds beginning in August by cutting off hospitals' Medicare fee-for-service reimbursement. Hospitals say their payments remain the same.)
Verma: You know, that's something that we're looking at and obviously something that Congress is also grappling with. I will say that we understand that COVID has had a significant impact, and what we're seeing in the numbers is that services are starting to come back up. On the hospital side, we're definitely seeing inpatient picking up, getting back to some of our pre-COVID levels, even higher. It's been a little bit slower on (the Medicare) Part B side as well. So we're looking at different options at this point, but we want to do everything we can to support providers on the front lines.
MH: Are you able to relax repayment terms or is that something that Congress must do?
Verma: Those are some things that we are looking at and I know that Congress is looking at that too. We've provided a lot of technical assistance to many Hill members on both sides of the aisle, so I think there's a lot of interest in this all across D.C.
MH: When will the rest of the CARES Act provider relief funds be distributed?
Verma: As you know, we've been putting distributions out, and I think that we've also held back some funds, because things change and there are evolving needs. One of the distributions that we just made this week was to nursing homes. We've probably put out $20 billion to nursing homes, but this $2 billion was around I would say more of a quality program, where it was actually giving them incentives for being able to mitigate the spread of the virus inside the nursing homes. So again, as things change with the virus, there's an evolving strategy, and we try to target the funds where it's most needed.
MH: Does CMS have a role in the COVID-19 vaccine distribution strategy?
Verma: We've been working with Operation Warp Speed as well. Obviously, we are looking at things like making sure that providers are reimbursed for the administration fee and that providers are enrolled in the Medicare program. We're working hand in hand and we're part of that, not necessarily distribution side of it, but the payment. Now the cost of the vaccine will be covered by the federal government, but where our programs will come into play is paying for the administration.
MH: Do you see any challenges with that and how would you address them?
Verma: We pay for vaccine administration today, so we're building it off that system, and we're trying to understand some of the unique things with the COVID vaccine, so there may be some additional costs for storage. There may be additional costs just because some of these vaccines are not just one shot. They're two. So we're trying to look at all of the different vaccines and what the unique requirements may be for those particular vaccines and we'll come up with a reimbursement strategy around that.
MH: There have been some recent announcements expanding the role of pharmacists. The most recent one was about pediatric vaccines. I'm wondering if you're looking at expanding the role of pharmacists further to address physician shortages?
Verma: One thing that we know about pharmacists is that they are conveniently located throughout our country. So we've been working with the pharmacies not only around the vaccine or contemplating their role with the vaccine administration, but we also have seen a larger role for them in testing, and they've really been great partners in helping us to expand the availability of testing. I think Medicare made some changes to the program to allow for that as well.
MH: Could COVID-19 be a barrier to the adoption of the ESRD Treatment Choices model, as patients often must have a surgical procedure before beginning in-home dialysis. (The agency on Friday unveiled its alternative payment model for patients with chronic kidney disease, with the goal of encouraging more home dialysis and kidney transplants.)
Verma: Actually, when we looked at the data and analyzed our Medicare beneficiaries and the impact that COVID was having, our end-stage renal disease patients were at the top in terms of hospitalizations and rate of infections, so it's really had a considerable impact on this community…For us, it really spoke to the importance of home dialysis, and even in the midst of COVID….We just felt like it was so important, because for people that have ESRD they've actually had to go in for their dialysis during all of COVID and especially in bigger cities, they had to public take transportation so it's actually put them at higher risk.
MH: What about telehealth expansions? What will be made permanent? (CMS expanded access to and payment for telehealth amid the COVID-19 pandemic, but the expansions were made under temporary waivers.)
Verma: So that's something that the president's particularly focused on. He put out an executive order and he wants to make the telehealth benefit more permanent, in terms of the waivers we've been able to do because of COVID. There's like three or four areas there. No. 1 is we've expanded the number of services that can be provided via telehealth. Unfortunately, without Congress' help we can't do that beyond rural areas, and we also can't allow the individual to obtain their telehealth services from their homes. So those are some things we're working on with Congress. But under the president's leadership we've expanded the number of services.
One of the things we've heard across the board, when you do roundtables like this and you talk to providers, is how encouraged everybody is about telehealth. Providers I think were originally a little reluctant, but they use it, and I think the patients have really appreciated it. Now that we're seeing the economy open up some of the telehealth numbers have gone (down), which we expected because now people are being able to get in-person visits, and we don't anticipate that telehealth is going to replace in-person care, but we see it as a tool that can augment what the provider is doing. It's another tool in the toolbox and that there are some cases where it may be more convenient.
Verma: As you can imagine with COVID, CMS, in addition to our normal payment schedule rules, we've put out three interim final rules which had a large impact on the healthcare delivery system but because of that we had to suspend a lot of the work we were doing. So we continue now that we've kind of gotten past a lot of that, and all of the waivers and rules are in place, we are focused on kind of continuing the work that we were doing. I would say that putting patients over paperwork is a high priority, and that was one thing when we went on our listening tour very early in the administration that providers brought up, was the difficulties with the Stark law. So we are working on that. And I think it's also just really important to the work we are doing around value-based care. We know that that has been a significant barrier for providers to advance value-based care, so rest assured people are working on it and we want to get it out as quickly as possible.