CMS Administrator Seema Verma Discusses Price Transparency, Value-based Care, and COVID-19

CMS Administrator Seema Verma spoke with HealthLeaders about healthcare policy less than a week before Election Day.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma has been busy over the past few weeks.

In mid-September, the agency withdrew the proposed Medicaid Fiscal Accountability Regulation (MFAR) rule, then a month later, CMS approved Georgia's new Medicaid section 1115 demonstration called "Pathways to Coverage."

Just over a week ago, Verma announced that the agency would delay the Radiation Oncology Model until July 2021, and on Thursday, CMS released its long-awaited and controversial final rule on price transparency.

Related: CMS Issues Long-awaited, Controversial Final Rule on Price Transparency

Shortly after the rule was released, Verma discussed the policy at a virtual roundtable hosted by the Center for Value-Based Insurance Design at the University of Michigan.

Subsequently, Verma spoke with HealthLeaders about the final rule on price transparency, the administration's plans to advance value-based care, how CMS plans to assist health systems dealing with the pandemic, and the implications of the upcoming election.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: What would you say to hospital executives who have been resistant to the administration's price transparency rule?

Verma: First, I would say that there are people that just want to protect the status quo because it works for them, but it doesn't work for the American patient. It's simply just not fair that people go in to seek healthcare services and they have no idea what something is going to cost. It doesn't happen in any other industry across the country and it shouldn't happen in healthcare. [The administration] thinks that this is not only something that's a win for patients, and the experience that they have with the healthcare system, but it has larger implications.

Our country is struggling to pay for healthcare, whether it's the Medicaid program for states or the Medicare program, where the trustees have warned that the program has significant funding issues. Price transparency brings market forces, it brings competition to the marketplace so that providers are competing on the basis of cost and quality. That's what's going to drive down costs and increase quality in the healthcare system because the status quo is unacceptable and unsustainable.

Related: Citing Stakeholder Concerns, CMS Withdraws the MFAR

HL: If President Trump is reelected, what are your goals for advancing value-based care? What are some other initiatives you're looking to pursue as a way to advance market-based healthcare reform? As a follow-up, if Trump is not reelected, what would you like or expect to see the Biden administration pursue that is in line with your policy agenda?

Verma: A lot of these efforts, whether it's price transparency or value-based care, enjoy broad bipartisan support and I think people across the healthcare industry recognize that these are the things that we need to do to make our healthcare system is more sustainable and more accessible for every American.

In terms of what the next administration [might] do, I can't speculate on that. I think the Trump administration is going to continue to deliver on the agenda that we've had. We've been tackling long-standing problems in the healthcare system across the board. We're tackling complicated issues: drug pricing, kidney care, price transparency, and interoperability. There've been so many issues that we've been trying to address. I think some of the next steps that are important here are continuing our efforts around surprise billing and I think today's efforts takes a step in the right direction.

Price transparency is one part of the picture. We want to empower patients with both price and quality transparency. We've been putting out quality information, but I think we need to also continue the reform of the quality metrics to make them more usable for patients and to be able to combine price and quality information to truly empower patients and create a competitive marketplace.

Related: Verma: Radiation Oncology Model Delayed Until July 2021

HL: On the topic of surprise billing, you talk about wanting to do more, is that something that comes from CMS or is that something where you're looking for additional congressional action?

Verma: I think one of the things that we found is even when there is support, there's a lot of inaction from Congress, and that's why this administration hasn't waited. We've continued to drive down and use the regulatory flexibilities that we do have to deliver better healthcare for the American people. If you look at the work that we've done on healthcare monopolies, the 340B pricing, site-neutral payments, or interoperability, all of these efforts are in absence of Congress's support because there hasn't been any work on that.

So, in terms of surprise billing, I think today's effort will make transparent out-of-network costs and that's important. If a patient is going to an out-of-network provider, or even an in-network provider, they're going to be able to clearly see what they may be potentially charged.

Related: Seema Verma's American Dream: Empower Consumers, Unleash Competition

HL: Where does the administration stand in terms of crafting a potential replacement plan for the Affordable Care Act (ACA)?

Verma: The most important thing to point out here is that we're fighting because we want to make sure that all Americans have access to affordable coverage, and we know that that's not the case. Some people just want to throw more government money at the problem, but this president wants to solve the problem. [Trump] has made it clear that he's going to continue to protect people with pre-existing conditions, we're not going to just strip coverage away from people and we're going to make sure that whatever happens, that there'll be a transition here. In terms of the ACA, we want to keep what's working and get rid of what's not.

HL: And when you say, "what's working," what does that mean?

Verma: [Like] today's efforts; we've leveraged some of the authorities in the ACA to make progress on price transparency. So that's an example of the types of things in the ACA that would be maintained.

HL: As it relates to the pandemic, what are some additional efforts, in the absence of a stimulus bill, that CMS are taking or aiming to [implement] to assist hospitals and health systems?

Verma: On the financial standpoint, on the accelerated payments, Congress is allowing for some more flexibility in terms of repayment, so they've extended the time to repay those loans. That's a significant development. Through the Provider Relief Fund, we've distributed over $100 billion, so those dollars have been helpful in supporting hospitals on the front lines.

I can tell you that we look at the Medicare data and a lot of what we're seeing is that many healthcare systems are now kind of coming back. We're seeing that levels of utilization are starting to come back in terms of elective surgeries and preventative services. That being said, we're going to continue to support our providers on the front lines. We know that this has been a difficult time, especially for our rural providers. Everybody wants to see that hospitals are able to keep their doors open, continuing to provide high quality care to Americans, and so we're going to do everything we can to support them.

HL: Is there any expectation that CMS would revisit its guidance that was put out in the spring to temporarily suspend elective surgeries, which are a major generator for hospitals?

Verma: I hope that that's unlikely. A lot of [the guidance] was [based] on where we were in terms of PPE at the time, but I think we're in a different place at this time. You talk to hospitals across the country and they say, 'We have months' supply of PPE.' It's going to be up to every local community and every hospital to make that decision. We also want to make sure that hospitals have the capacity to deal with patients that do have COVID-19. But in terms of the federal level, I think this is going to be a local decision because we feel like they have appropriate supplies of PPE.