It's a Wrap
New Survey and Operations Group Areas of Focus
Consistency was the theme for Sandra Pace, acting director for the new CMS Clinical Standards and Quality Survey and Operations Group, the "boots on the ground" that visits CMS-certified facilities to see "what our funds are paying for…how well are they carrying out our mandates, our regulations, our policies."
The Group is focused on providing uniform guidance for all providers. Two priority areas Pace discussed include consistent guidance on the use of antipsychotic drugs in long-term care settings and on triage procedures performed in the context of the Emergency Medical Treatment & Labor Act (EMTALA) - which ensures public access to emergency services regardless of the ability to pay.
Rethinking Rural Health
Cara James, director of the CMS Office of Minority Health, described the expanded role of telehealth that CMS supports for rural health care settings. CMS now covers short phone assessments, bundled treatment of opioid use disorders, more preventive services and remote evaluation of pre-recorded patient information. The hospital wage index was also increased for many rural hospitals.
James noted that more than half of women in rural communities don't have access to hospital obstetric services. CMS is still gathering feedback to address this issue through a Request for Information open until April 12, 2020: visit go.cms.gov/ruralhealth to learn more.
2020 CMS Health Equity Award
Two organizations were recognized with the CMS Health Equity Award this year for their efforts to "give people what they need to achieve their highest level of health," James said.
"So many times when doing this work, I hear, 'these are intractable problems. We haven't been able to address disparities. It's just not possible,'" said Cara James. "Well, we're here to tell you that it is possible. And we're here to celebrate those who have made it possible."
UnitedHealthcare was recognized for its work to reduce disparities in timely postpartum care among Black and rural women enrolled in its Medicaid programs in Michigan, Ohio and Hawaii between 2018 and 2019. Atrium Health was recognized for significantly reducing racial and ethnic disparities in colorectal cancer screenings in Hispanic men between 2018-2019.
Fireside Chat: Data, Technology, Interoperability and the Future of Our Health System
Several CMS technology leaders came together to talk about recent innovations - and what's to come - in a discussion led by Shannon Sartin, chief technology officer for the CMS Center for Medicare and Medicaid Innovation.
One big success is Blue Button 2.0, which makes Medicare claims data available to beneficiaries. The program transitioned to a Fast Healthcare Interoperability Resources (FHIR) format in 2018 and paved the way for 55 apps in production to benefit people with Medicare today. Spin-offs of the Blue 2.0 project are piloting programs to ease accountable care organization (ACO) access to CMS data files and to provide real-time data to clinicians through electronic health records (EHRs). Sartin noted that more than 70,000 providers expressed interest in the EHR pilot within the first few months of its launch.
Allison Oelschlaeger, chief data officer and director of the CMS Office of Enterprise Data & Analytics, described how CMS addresses privacy and security within the Blue Button apps. "Part of the CMS vetting process includes a review of privacy policies to make sure they're written in plain language and it's something that beneficiaries can actually understand," Oelschlaeger said. "We want to understand how the app is storing information and how [data] is being protected. It's helping beneficiaries make good choices about sharing their data."
Fireside Chat: Drug Pricing
Recent changes to CMS policies will have a ripple effect on drug pricing in the years to come, asserted Senior Advisor to the CMS Administrator Dr. Jeet Guram in a fireside chat led by Jean Moody-Williams, acting director, CMS Center for Clinical Standards and Quality.
"CMS is quite possibly the largest purchaser of prescription drugs on the planet. So, across our programs, changes in our policies are going to have downstream consequences for the rest of the market and are going to influence the extent to which competition is a force and how payment policies play out for all consumers…we have a lot of potential to do good, and there's a real need," Guram said.
Cheri Rice, deputy director, Parts C and D, CMS Center for Medicare, noted several important changes within Medicare Part D designed to negotiate better prices and better spending for Medicare Part D beneficiaries. Generic drugs are now immediately covered by Medicare Part D plans. New this year, Part D plans can now tailor their formularies to cover drugs for specific indications. This will allow plans to negotiate deeper discounts with pharmaceutical manufacturers.
In addition, Part D plans are now required to offer provider tools that provide information about drug coverage for their patients at the point of prescribing. These tools are hosted by e-prescribing systems or electronic health records and include real-time out-of-pocket drug costs and utilization management requirements. A requirement for a similar tool for beneficiaries is proposed for 2021.
Moody-Williams greeted the conference audience with yá'át'ééh, a Navajo greeting she learned earlier that week at a panel about improving care for Native Americans and Alaska Natives. Yá'át'ééh means, "it is good."
And the recurring themes Moody-Williams summarized from the 2020 conference were all good: providing transparency and better information for consumers; aligning quality measures and transitioning to digital measurement; reducing burden, duplication and unnecessary paperwork; spotlighting social determinants of health, kidney health, diabetes management and substance overuse; and being good stewards of health care dollars.
"We are now empowered to go home and change the world," Moody-Williams said in closing. " Go out and make a difference in someone's life. And make sure at the end of the day we can say, 'it is good.'"