CMS Administrator Seema Verma: What Industry Can Expect
The Senate confirmed former health-policy consultant Seema Verma as administrator of the US Centers for Medicare and Medicaid Services earlier this month, and she was sworn in March 14. Medtech Insight took a look at some of Verma's policy positions affecting industry, including potential changes to accountable care organizations, appropriate-use criteria, the Centers for Medicare and Medicaid Innovation, lab payments, and telehealth services.
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In a proposed rule, the US Medicare agency said clinicians may count use of advanced imaging appropriate use criteria (AUC) through clinical decision support as a new and highly-weighted portion of an overall score to win reimbursement through the Merit-Based Incentive Payment System. The move was touted by the imaging industry.
The shift in health care reimbursement from a fee-for-service model to one which is based on value and an emphasis on accountability for care quality and health care costs is here to stay. In orthopedics, as in other therapy sectors, physicians are having to grapple with new alternative payment models and meeting the requirements that come with these new reimbursement methods. Strategies for adopting these value-based systems, including challenges and trends, and what it all means for surgeons, dominated much of the discussion at this year's American Academy of Orthopaedic Surgeons (AAOS) annual meeting in San Diego.
The US Medicare agency will allow laboratories two additional months – until May 30, 2017 – to report their private-payer pricing data, which will serve as the basis for clinical laboratory Medicare reimbursements starting in January. The agency said it is responding to industry feedback that more time is needed to collect the data.