"We must shift away from a fee-for-service system," Verma Writes

As federal healthcare policy roils in Congress once again, the Centers for Medicare and Medicaid Services has announced its pursuit of a “new direction” to promote patient-centered care.

“We will move away from the assumption that Washington can engineer a more efficient health-care system from afar,” CMS Administrator Seema Verma wrote in a Wall Street Journal op-ed today. Her op-ed coincides with the launch of an informal Request for Information run as a survey online.

“We must shift away from a fee-for-service system that reimburses only on volume and move toward a system that holds providers accountable for outcomes and allows them to innovate,” the op-ed says. “No central planner gave Henry Ford a set of rules and instructions to manufacture the Model T.”

Verma’s op-ed repeatedly stresses a need for providers to have freedom in order to innovate, and also that it is important to empower patients to seek value. “They also need incentives to be cost-conscious. Patients can define value better than the federal government can,” she wrote.

The survey poses potential models and policy adjustments asks respondents if they have comment on them. One of the first questions calls for input on the “structure, approach, and design” of hypothetical “Expanded Opportunities for Participation in [Alternative Payment Models].”

The next line of questioning surrounds models that CMS says it is considering for consumer-provider interaction, “which include allowing Medicare beneficiaries to contract directly with healthcare providers, having providers propose prices to inform beneficiary choices and transparency, offering bundled payments for full episodes of care with groups of providers bidding on the payment amount, and launching preferred provider networks.” Such testing is possible under the Centers for Medicare and Medicaid Innovation (CMMA), created in 2010.

Over the summer, the Department of Health and Human Services (of which CMS is a part) seemed to back off of bundled payments, requesting a cancellation of policy that would require mandatory bundles for certain cardiovascular procedures. Prior to becoming HHS Secretary, Tom Price had written a letter to the CMS in which he expressed concerns that bundled payment requirements represented “experimenting with Americans’ health.”

Verma is a longtime critic of the Affordable Care Act, which new Republican legislation will again attempt to repeal. She has said that she questions “whether Medicaid is the best vehicle," for populations that received coverage under the ACA’s Medicaid expansion.

“Our goal is to increase flexibility by providing more waivers from current requirements,” she writes in the new op-ed. The survey will be open for comment through November 20^th. “There are a lot of great ideas, and we want to hear from people on the front lines. No government agency has all of the answers, especially in an industry as large and multifaceted as health care,” Verma wrote.