WHAT THEY ARE SAYING | CMS ADVANCES AGENDA TO RE-THINK RURAL HEALTH AND UNLEASH MEDICAL INNOVATION

Last week, the Trump Administration proposed changes that build on the progress made over the last two years that furthers the agency’s priority to transform the healthcare delivery system through competition and innovation while providing patients with better value and results. The proposed rule would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2020 and advances two key CMS priorities, “Rethinking Rural Health” and “Unleashing Innovation,” by proposing historic changes to the way Medicare pays hospitals.

To read more about these historic proposed changes visit: https://www.cms.gov/newsroom/press-releases/cms-advances-agenda-re-think-rural-health-and-unleash-medical-innovation

President Roy Silverstein, MD
American Society of Hematology (ASH)

“CMS recognizes the consequences of not keeping up with innovation. ASH is pleased that the agency is currently examining its existing payment policies to identify ways to more realistically account for the costs of administering this life-saving therapy. The proposed rule, released yesterday, would increase the payment given to institutions for new technologies, such as CAR-T, to 65 percent, which would reimburse centers for 15 percent more of the product cost than they receive now. While ASH had originally suggested a higher payment, any increase is an improvement.”

Scott Whitaker
President and CEO of the Advanced Medical Technology Association (AdvaMed)

“This proposed rule is a significant step forward in providing patient access to truly life-changing technologies. The language captures the importance that CMS Administrator Verma has placed on these innovations, and the role they play in treating human suffering while addressing the challenges facing our health care system. We commend her hard work and that of her staff.  We are pleased that this rule reflects several of AdvaMed’s priorities, including increasing funding for new technology add-on payments (NTAP), and making it easier for breakthrough technologies to access the Medicare program. This will help ensure that hospitals and patients have access to breakthrough innovations and care, and further incentivize transformational technologies.”

Executive President Tom Nickels
American Hospital Association

 “The AHA looks forward to reviewing in detail the proposals CMS put forth today that cover inpatient and long-term care hospital services under Medicare. Based on our initial review, we are pleased that the agency has increased the new technology add-on payment rate, including for CAR-T therapies. Hospitals and health systems have been taking on this financial burden to ensure access to these life-saving treatments for patients, and while this proposal is not a permanent solution, it will help in the short-term. In addition, we are strongly supportive of the proposed 90-day reporting period for attestation for the Promoting Interoperability Programs, a move that will reduce regulatory burden on hospitals.”

President Mary R. Grealy
Healthcare Leadership Council

“One of Medicare’s long-standing flaws has been the program’s inability to keep pace with transformative improvements in medical science and technology. This proposed rule is a major step in a very necessary direction, better enabling patients to have access to the treatments and therapies that can save and strengthen their lives. Compliments to Administrator Verma and her team at CMS for understanding the role of innovation in improving healthcare quality and containing costs by improving population health.”

Executive Vice President and Chief Policy Officer Danne Howard
Alabama Hospital Association

We could not be more grateful to CMS Administrator Seema Verma and her staff for listening to our concerns and taking action,” Howard said.  “Alabama has been penalized for decades by this flawed formula, which has resulted in some states being paid three times as much as Alabama’s hospitals for the exact same procedure.  Alabama’s entire congressional delegation worked tirelessly in a non-partisan manner to make this happen, and we specifically would like to acknowledge Sens. Richard Shelby and Doug Jones and Rep. Bradley Byrne for leading the charge.”

The Alliance for Aging Research

“The Alliance for Aging Research applauds CMS’s proposal to create an alternative payment pathway to increase access for breakthrough medical devices. The Alliance supported establishing the Breakthrough Devices Program at the U.S. Food and Drug Administration’s (FDA) Center for Devices and Radiological Health (CDRH) as part of the 21st Century Cures Act. The program created a priority review process for medical devices intended for use in patient populations with life-threatening illnesses and for areas of unmet need. But, while the new FDA program expedited device review and market entry, it did not necessarily increase patient access. The proposed CMS add-on payment pathway is a major step toward getting transformational treatments into the lives of more Medicare beneficiaries that need them. We believe timely access to cutting-edge medical devices is vital to the health and independence of older adults. Improvement in function and well-being is what healthcare should be about—and that is priceless.”

Alan Morgan
CEO of National Rural Health Association

“This @CMSGOV announcement includes significant changes impacting #ruralhealth. @NRHA_Advocacy is reviewing the changes- Full analysis coming soon. #RuralHospitals” – tweet from @Amorganrural.  

Chairman Lamar Alexander (R-Tenn)
Senate HELP Committee

“This is an important step to help protect Tennessee hospitals from shrinking Medicare reimbursements that make it harder to recruit skilled doctors and nurses, make payroll, pay bills and care for patients. Senators Isakson, Shelby, Jones, Perdue, Blackburn, and I asked Administrator Verma to address this problem, and I am glad that CMS has now proposed a solution. I look forward to learning more about how the new rule will benefit Tennessee’s rural hospitals.”

Ranking Member Kevin Brady (R-Texas)
House Ways & Means Committee

“I applaud the Trump Administration for their commitment to improving health care for all Americans – especially for those who live in rural areas. Nearly 20 percent of Americans live in rural areas, and this proposed regulation for inpatient and long-term care hospitals represents an important step toward bringing stability and improved access to quality health care for folks in rural America. I also applaud the Trump Administration for taking important steps to promote innovation and competition to ensure Americans have access to transformative medical technology.”

Sen. Richard Shelby (R-Ala)

“The Medicare Wage Index has negatively affected Alabama hospitals for over 20 years,” said., who wrote a letter last month signed by the state’s congressional delegation to Center for Medicare and Medicaid Services Administrator Seema Verma requesting a change to the index. After two decades of working to address a problem that significantly contributes to heightened hospital closures throughout our state, I am glad to see Administrator Verma and CMS taking steps to solve this dire issue. I look forward to continuing my work with the agency to make sure that this sort of careless imbalance is eliminated moving forward.”

Sen. Doug Jones (D-Ala)

“The decision by CMS to propose a new reimbursement formula is welcome news and a great first step for the health care providers across our state who have struggled for years with an inexplicably low reimbursement rate,” the senator said. “These hospitals provide care to all Alabamians, regardless of their insurance status, and they have to absorb the costs when that care isn’t reimbursed. That puts the entire system on slippery financial footing and can hurt the broader community if a hospital is forced to close its doors.”

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