Verma: CMS is exploring ways to expand site-neutral payments

Seema Verma
CMS Administrator Seema Verma said her agency is interested in expanding site-neutral payments. (YouTube)

Following a proposal that would change the way Medicare pays for clinic visits, the Trump administration is looking at ways to expand site-neutral payments to other areas of care.

Post-acute care could be one of those areas, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma told audience members at an event hosted by The Economist Group on Wednesday morning.

“We are taking a look at [site-neutral payments] across the board and looking at our authority and where we can weigh in on it,” she said. “But I think the post-acute space is something where there are a lot of differentials in payments and something we’re very interested in exploring.”


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

Verma was responding to an audience member that asked specifically whether CMS was considering site-neutral payments for post-acute care. MedPAC, which makes policy recommendations to CMS, has long supported site-neutral payments for several post-acute care conditions.

RELATED: CMS proposes site-neutral payments in OPPS rule aimed at boosting provider competition

The agency has already received some industry pushback for a proposed rule issued in July that would create site-neutral payments for clinic visits, the most common services billed through the outpatient prospective payment program. CMS said that proposal would save the Medicare an estimated $760 million in 2019 alone.

But hospital groups, including the American Hospital Association, have long opposed such a shift in payments that would lower hospital reimbursements. In a recent letter to CMS, AHA said the change could lead to patient access issues, and hinted that it could take legal action if the rule goes through.

At the same time, policy experts have been largely supportive of the shift that would create more equitable reimbursement between providers.

An August analysis by experts with the USC-Brookings Schaeffer Initiative for Health Policy commended CMS for its initial step, but urged the agency and lawmakers “move expeditiously to implement site-neutral payment as broadly as possible in the Medicare program.”

Ultimately, however, CMS may need help from Congress to enact widespread implementation.

“I think we will likely need help from Congress to get where we want to go, but again, what we’re trying to do at CMS is look at every lever that we possibly have within the program,” Verma said. “So, it could be a combination of things.”

Suggested Articles

We need our federal programs and policies to reflect the goal of improving the health of both women and men.

Two lawsuits were filed suing the Trump administration to overturn a new rule that would allow healthcare workers to deny care over religious or conscience…

Policy changes are affecting how investors view the skilled home health market and paving the way for potential strategic acquisitions.