The Trump administration tried unsuccessfully to overhaul both Obamacare and Medicaid, but now they are trying to put its stamp on Medicare.
The Centers for Medicare and Medicaid Services has issued many proposed rules in recent weeks. They would change how doctors and hospitals are paid for treating senior citizens and give insurers in the Medicare Advantage program more control over the medications doctors can prescribe.
The agency maintains that its proposals would give patients more control over their health care, reduce doctors’ paperwork, cut Medicare’s cost to taxpayers and help insurers lower drug prices. Health policy experts say some of the changes could ease seniors’ costs, but could also make it harder for them to see their doctor of choice or get medicines their physician recommends.
The first thing that the Trump administration wants to do is change how doctors are paid for office visits. Currently, Medicare has five levels of payments, ranging from a quick visit with a nurse to an in-depth evaluation of patients with cancer, heart failure or other serious illnesses. The agency is proposing to reimburse doctors the same amount regardless of the person’s condition and the length of the visit.
The change aims to let providers spend more time with their patients and less on documentation, said Seema Verma, administrator for the Centers for Medicare and Medicaid Services.
”This would create incentives for many more short visits,” said Robert Berenson, an institute fellow at the Urban Institute who was in charge of Medicare payment policy at the agency during the Clinton administration
The second change would be to limit payments to hospitals for outpatient visits. Medicare currently pays more for a visit at a hospital off-site outpatient clinic than at a doctor’s office. The agency is proposing what it calls “site-neutral” reimbursements, meaning it would pay the same amount no matter where the patient is seen.
“Medicare pays for things differently based on the site of care, paying more or less for the same service, but different locations,” Verma said in a speech last month. “Now sometimes it makes sense, as some facilities provide a higher level of service. But other times, it creates misaligned incentives — decisions about whether a patient receives a service in a hospital or in a doctor’s office is influenced by how Medicare pays.”
The move could save Medicare $760 million in 2019, and it would lower patients’ co-pays to an average of $9, down from $23, each time they visit an off-site clinic, according to the agency.
The third change would be to give Medicare Advantage plans more control over medications. As part of its promise to lower drug prices, the agency will give Medicare Advantage plans more power over the medications physicians administer in their offices.
“By allowing Medicare Advantage plans to negotiate for physician-administered drugs like private-sector insurers already do, we can drive down prices for some of the most expensive drugs seniors use,” said Health Secretary Alex Azar.
And the final change would be to curb Accountable Care Organizations.
The agency wants to make significant changes to the main Medicare Accountable Care Organization program, which has 10.5 million participants. Established by the Affordable Care Act, these organizations are groups of doctors, hospitals and other providers who voluntarily work together to better coordinate patients’ care and reduce health care costs by avoiding duplication of services and medical errors.
The agency wants more of these organizations to share the risk if their spending per patient exceeds their targets.