Seema Verma on Tuesday laid out a sweeping plan for data-driven oversight and enforcement throughout the well being care spectrum, and took a equally broad view of her company’s regulatory plans when immediately requested about potential adjustments to the brand new Medicare cost mannequin for nursing properties.
Particularly citing the early success of the company’s current push to bolster nursing dwelling oversight, the Facilities for Medicare & Medicaid Companies (CMS) administrator rolled out a four-part plan focusing on the whole well being care business — centered round establishing clear efficiency benchmarks, boosting enforcement efforts, selling transparency, and bettering high quality outcomes.
“Final 12 months, we launched a framework for guaranteeing security and high quality in nursing properties,” Verma mentioned in a speech on the 2020 CMS High quality Convention in Baltimore. “This framework has formed all of our work on nursing dwelling high quality, and actually, was so profitable that we determined to duplicate it throughout the company and in all our applications in 2020 and past.”
That initiative has manifested itself in quite a lot of strikes from CMS, from the introduction of a controversial warning icon for nursing properties with current experiences of abuse to a coming overhaul of the Nursing House Examine web site for customers.
However when requested if the enforcement push will lengthen to the brand new Affected person-Pushed Cost Mannequin (PDPM), Verma framed the CMS reform efforts as extra inward-facing.
“That second one, round enforcement and oversight, I believe is extra inner, the place we’re reorganizing in order that we will do a greater job of getting oversight over nursing properties — and actually, fairly frankly, all well being care amenities,” Verma mentioned on a post-speech name with well being care reporters, referring to the second of CMS’s 4 details.
CMS’s response — or potential lack thereof — to altering supplier conduct within the speedy wake of PDPM stays the biggest open query in regards to the new Medicare cost mannequin.
With the primary spherical of earnings experiences from publicly traded expert nursing facility operators and landlords practically full, the business has virtually unilaterally agreed that the change has been impartial to optimistic, with a number of experiences of modest income will increase.
CMS’s acknowledged aim of finances neutrality for the brand new cost mannequin has raised some considerations that the federal authorities could modify charges downward sooner or later to compensate for the early features, and even claw again among the extra funding as soon as it has an opportunity to completely vet the information.
However no less than from the business’s perspective, these fears stay unfounded.
“I really don’t count on a clawback. I believe CMS, regardless of some feedback, anticipated some optimistic progress,” Sabra Well being Care REIT (Nasdaq: SBRA) Rick Matros mentioned throughout his firm’s fourth-quarter 2019 earnings name earlier this week.
Talking on the eCap well being care summit in Florida final week, American Well being Care Affiliation CEO Mark Parkinson took issues a step additional by positing that there merely isn’t sufficient time for CMS to implement any sweeping PDPM adjustments this 12 months — and that any changes would seemingly are available October 2021, the beginning of the federal authorities’s 2022 fiscal 12 months.
“I don’t suppose that CMS has, or now we have, sufficient data now to at the moment act,” Parkinson mentioned.
Whereas Verma didn’t delve into the specifics of CMS’s pending PDPM plans, she emphasised on the decision with reporters that the company will proceed to regulate high quality.
“As these new insurance policies are applied, it doesn’t change our dedication to high quality take care of sufferers,” she mentioned. “It’s a distinct cost system. However the assurance round high quality and security has not modified.”
As CMS has prior to now, Verma in her ready remarks vowed to include extra consumer-focused data into its high quality measures and reporting, whereas additionally utilizing expertise to extra intently monitor operators. Specifically, she described a future by which business stakeholders and clinicians might ship data to a single, centralized submission system, whereas authorities officers monitor medical information and outcomes immediately from operators’ digital well being document (EHR) programs.
“Transferring to a system the place we’re capable of take high quality information from the EHR, we will mix it with claims information, we will see what’s happening in program integrity,” Verma mentioned on the decision. “And we must always be capable of determine these high-quality suppliers on the entrance finish, after which determine the place now we have weaknesses — I believe, in a manner, that’s been pretty unprecedented.”
As well as, CMS is working to streamline its expectations and high quality measures throughout Medicare, Medicaid, and Medicare Benefit, Verma mentioned through the dialogue with reporters.
“We need to have one set of measures, so suppliers aren’t coping with completely different measures,” she mentioned.
As well as, Verma touted the success of the company’s complete nursing dwelling reform plan in her speech, pointing to CMS’s efforts to standardize processes throughout the 10 regional workplaces that oversee state-level expert nursing facility survey businesses.
“We at the moment are utilizing the identical instruments, conducting opinions in a extra systematic and goal method, and utilizing information analytic instruments to judge their efficiency,” she mentioned in her ready remarks. “We’re additionally submitting instances with vital points to a committee of CMS employees from throughout the nation to make sure that enforcement selections [are] honest and constant.”