Former Centers for Medicare and Medicaid Services officials had some hard-won advice this week for current Administrator Seema Verma when it comes to handling the challenges of the job.
Get out of the office and talk to people.
"The outside world clamors to better appreciate what is that black box of CMS. And the more you interact with people—whether it's associations, whether it's individuals, however it is that you listen—I think you'll make better policy because you'll better appreciate the very fast-changing nature of what is the healthcare space," said Leslie Norwalk, strategic counsel to Epstein Becker & Green, P.C., who served as CMS' Acting Administrator under the George W. Bush administration.
Norwalk spoke alongside four former CMS officials sharing the stage at that the American Hospital Association meeting in Washington, D.C., this week, when they were asked to share their best bits of wisdom from their stints in the role.
She said it's helpful, for example, that Verma took the time to speak at AHA on Monday, but that she could have done more.
"It's great that she gave a half-hour speech. It'd be good if she'd taken some questions because I think can learn a lot from what people ask you," Norwalk said.
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Gail Wilensky, who formerly served as the administrator of what is now called CMS under the George H.W. Bush administration, said she always visited neonatal intensive care units in cities she visited because it represented the best and most frustrating part of healthcare delivery.
"I was amazed by what we could do keeping young, very premature babies alive and frustrated by the causes that so often put them there that ought to be preventable," said Wilensky, who is a senior fellow at Bethesda, Maryland-based health services organization Project HOPE.
But she also said she'd advise her to pay close attention to the pushback from physicians and associations regarding the implementation of payment reform law known as MACRA, which will change the way that Medicare rewards clinicians for value over volume and also come with potential penalties.
In particular, she pointed to the new Merit-Based Incentive Payments System, known as MIPS, and alternatives that have been floated to rework the system.
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"This is a place where she ought to see this train coming down the tracks at her, approach Congress and say, 'We need to be able to slow down the penalty phase because it is supposed to start in January and we're not ready,' Buy yourself another two years," Wilensky said. "Allow those that are already doing advance payment mechanisms to go ahead ... and get her new head of [Centers for Medicare and Medicaid Innovation] busy as fast as he can get his feet there to try out this or other alternatives."
Marilyn Tavenner, who didn't have a chance to answer the question in front of the audience, told a reporter after the session that her advice would also be about regulation and avoiding the unintended pitfalls, like the MACRA example, in the first place.
"I say it to myself all the time: 'If I had it to do over ..." Tavenner said. "Because you're working with 5,000 people who are all interested in policy, they are going to be writing policy all the time. So let's try to prevent the regulation on the front end and then we don't have to go back to figure out how to streamline it ... it's a lot better to not have it than to have to fix it."