Verma on PHE flexibilities: ‘I don’t think it’s possible to go back to business as usual’

OVERLAND PARK, Kan. – Seema Verma, former CMS administrator and a new member of WellSky’s board of directors, shares her thoughts on everything from health care software to PHE-related flexibilities to competitive bidding.  

HME News: Can you talk about the role that providers of health care software, analytics and services play in improving health care efficiency and outcomes?  

Seema Verma: Providers of health care software are on the frontlines, as they create the tools that every provider uses to deliver care. Software done well makes it easier for providers to deliver high quality care for their patients. On the back end, software delivers powerful analytics to help providers understand how the care they provide can be improved and where the opportunities are to lower costs and improve outcomes. 

HME: WellSky highlighted your work creating flexibility for health providers during the COVID-19 public health emergency. There has been a push to expand these flexibilities beyond the PHE. What are your thoughts on how the COVID-19 pandemic has changed how CMS and other health care payers view coverage and documentation? 

Verma: Regulatory burden is stifling innovation and contributing to the high cost of health care, provider burnout and staffing shortages across the country. COVID accelerated CMS’s Patients Over Paperwork Initiative, providing relief from over 100 waivers of regulations. For every flexibility CMS provided, we created a plan to evaluate the impact on program integrity and cost. It’s important that policymakers evaluate the impact of each waiver and determine which ones should be made permanent. I don’t think it’s possible to just go back to business as usual because, after this much time, the health care system has become acclimated to this new way of operating. 

HME: WellSky also highlighted your work driving telehealth and remote care across the health care system during the PHE. How do you think CMS and other health care payers should embrace telehealth and remote care beyond the PHE, while balancing concerns that this opens up Medicare to increased fraud and abuse? 

Verma: Telehealth should be made a permanent benefit. There is massive use of telehealth from all Medicare populations in every demographic. There is fraud, abuse and bad actors in every Medicare service line, so that’s not an excuse not to provide an innovative benefit that helps improve access and quality. It will never replace in-person care, but it’s a tool for providers and patients, and they should determine when it’s most appropriate.    

HME: More generally, how has the pandemic changed how CMS and other health care payers view post-acute care? 

Verma: Home health care has dramatically increased. Payers and providers are recognizing the key role they can play in improving access, reducing costs and improving quality. The advent of new technology will further support this shift to more home-based care. Government policies in Medicaid and Medicare fee for service will need to change to support the innovation, and unfortunately, that might be slow. But we should see greater adoption in Medicare Advantage plans, where private plans can be more flexible and nimble. 

HME: National competitive bidding has consistently been the biggest issue for the HME industry since it was implemented in the early 2010s. Do you think competitive bidding should continue beyond the most recent round, Round 2021, which included only off-the-shelf knee and back braces? 

Verma: The idea of competitive bidding is a good one, and I support market-based initiatives to lower costs and improve access. That being said, the Medicare competitive bidding program hasn’t delivered and, therefore, CMS will need to continue to make modifications.