The Trump administration is making transparency a “priority” as it embraces policies like step therapy, according to a top CMS official.
Demetrios Kouzoukas, principal deputy administrator at the Center for Medicare & Medicaid Services and director of the Center for Medicare, said that the agency is working across the healthcare system to ensure physicians and patients are more informed about Part D formularies and the drug options they have available.
And it wants to bring that same mindset to traditional Medicare, and though significant changes would require an act of Congress, CMS can always rethink its approaches to certain policies and find ways to adapt within the confines of its power.
“This is a real challenge,” Kouzoukas said Wednesday at the American Medical Association’s National Advocacy Conference.
Kouzoukas echoed Department of Health and Human Services Secretary Alex Azar who, in a speech on Tuesday, said that HHS officials were looking ways to address potential issues in step therapy, such as a beneficiary switching plans and thus having to start over.
Such an approach is “pennywise and pound foolish,” he said, and could end up hurting patients.
Despite that, Azar said that CMS remains bullish on step therapy as it looks to expand the practice into Medicare Advantage, allowing plan sponsors to use it for Part B drugs. Providers, including the AMA, have balked at the proposal.
Why CMS wants to avoid ‘snow globe healthcare policy’
Kouzoukas said the administration is rolling out polices that get away from “snow globe healthcare policy,” where government officials release new regulations and policies that shake up the healthcare system.
He said that these policies may leave doctors feeling like broken figures inside of a snow globe.
“I’m trying to see the Medicare program through their eyes,” he said.
An example of this approach, he said, is a CMS policy change that allows Medicare to pay for remote check-ins with patients on the phone and to pay physicians who review an image texted to them by a patient.
Medicare initially did not cover such services, he said, because they were considered a type of telehealth under the statute. However, the agency took a second look at its definition of telemedicine and was able to expand coverage for these services.
CMS has also made significant changes to documentation requirements for value-based care programs that are paying off for docs, Kouzoukas said. Eliminating certain quality measures and other steps will save the equivalent of 300 years of documentation per year beginning in 2021.
“Bureaucracy doesn’t heal the sick, even good bureaucracy—physicians do,” Kouzoukas said.