“This type of change in American healthcare delivery allows unintended consequences. I find it interesting to look up the professional biography of the physicians involved in making these changes. My experience is the vast majority of these doctors do not have qualifying experience delivering care to understand the complexity of this issue. Put me to the test and look up the practice experience of the top expert in this matter, Dr. Patrick Conway, chief medical officer at the Centers for Medicare and Medicaid Services, who oversees CMMI.” Bill Chesnut, MD
(Return to New Health News, https://billchesnutmd.com/new-health-news/)
Obama Administration working to reshape healthcare before next January. AMA News May 10, 2016.
STAT (5/10, Scott) reports that as January 20, 2017 approaches, “the Obama administration is racing to burnish its health care legacy, introducing major new initiatives that will take full effect just weeks before the president leaves office.” The article says the number of uninsured has dropped significantly because of the Affordable Care Act, yet, Administration officials are moving “to use other parts of the law to reshape how health care itself is delivered across the United States.” According to the Administration, “34 initiatives have been announced or are currently being tested at” the Center for Medicare and Medicaid Innovation.
WASHINGTON — As the clock ticks toward Jan. 20, 2017, the Obama administration is racing to burnish its health care legacy, introducing major new initiatives that will take full effect just weeks before the president leaves office.
The ranks of the uninsured have dropped dramatically since the passage of the Affordable Care Act six years ago. But administration officials are now hustling to use other parts of the law to reshape how health care itself is delivered across the United States.
They’re trying to tackle the biggest health care issue of the day — drug prices— and setting ambitious goals for revamping how primary care is provided. They have also undertaken significant new efforts when it comes to paying for surgeries and preventing disease.
What will happen over the next eight months is as much as these projects can be accelerated, they will be,” said Kathleen Sebelius, the former US Health and Human Services secretary. “The time clock is very much in everybody’s mind.”
Every administration tries to get as much done as it can before time runs out, but this White House has a tool that none of its predecessors did: an agency created by the Affordable Care Act and given $10 billion over 10 years to test new models for paying for and delivering health care.
The administration seems intent on stretching the authority given to this new agency, called the Center for Medicare and Medicaid Innovation, as far as it can in its final days. The agency, for instance, recently proposed a new plan for overhauling Medicare Part B drug payments — and it’s mandatory for many providers.
“They are definitely taking a broad interpretation of the authority and using it as a vehicle,” said Caroline Pearson, senior vice president at Avalere Health, an independent consulting firm. “They’re trying to push through as much regulatory reform as they can.”
The administration said that 34 initiatives have been announced or are currently being tested at CMMI.
Broadly speaking, the agency has stuck to widely supported ideas for improving health care. That means paying doctors as a group to treat a patient instead of for each individual service, which should foster cooperation. And it means encouraging preventive care to forestall more costly problems down the road.
“We believe delivery system reform, and the work of the innovation center, is truly bipartisan,” said Dr. Patrick Conway, chief medical officer at the Centers for Medicare and Medicaid Services, who oversees CMMI. “We think it will continue beyond this administration.”
But some of its work is highly controversial — and will still be in its infancy when the next administration takes over, putting it at risk of being undone.
The second part of the Medicare drug overhaul, which aims to encourage doctors to prescribe less expensive drugs without sacrificing the quality of care, is currently expected to take effect after Jan. 1, 2017.
The pharmaceutical industry is lobbying hard against it, and some physician and patient groups have also said they are deeply concerned. Republicans in Congress have already urged the White House to withdraw the proposal altogether. The opponents describe the plan as an overreach of what CMMI was intended to do and warn it could compromise the care that cancer patients receive.
“The part that maybe was unforeseen was the size of the demo, the fact that it was mandatory, the length of time that it was in existence, and the lack of detail about pretty significant changes” to drug payments from the insurance program, Lori Reilly, executive vice president of policy and research at PhRMA, told reporters at a recent briefing.
There is some disagreement about what would need to be done to undo what the Obama White House is trying to accomplish — Could a President Trump just sign a piece of paper? Or would he need to go through the regulatory process? What about any contracts that have been signed? — but everybody acknowledges that a GOP president and a Republican Congress could find a way to stop the plans that this administration has put into motion.
“If the Republicans win and get their acts together, I think Phase 2 never gets implemented,” Pearson said. “It probably doesn’t go anywhere.”