Jan 17, 2020

2019: What CMS Accomplished

Seema Verma
CMS Administrator

It’s difficult to overstate the significance of CMS’s mission. The agency’s actions affect millions of people, allocate over one trillion dollars and ultimately do much to influence America’s health. When I took on the position of Administrator, I was often advised to choose one or two areas of focus. Don’t take on too much, or you might not get anything done – so the advice went. But I perceived that the problems in American healthcare call for sweeping, not incremental, change. I also saw that CMS, tasked with such wide-ranging responsibilities, was capable of driving that sort of transformational shift. So we designed 16 strategic initiatives to transform the healthcare system by delivering affordability, accessibility and quality—in short, to put patients first at every turn. The hard-working and talented staff at CMS have validated my optimism to a degree even I had not expected.

These strategic initiatives guide our work, and the results are showing. Our end-of-year video nicely encapsulates some of the highlights. We’ve used best practices from private industry to make our programs more sustainable and available to vulnerable people who need them.

President Trump has an ambitious healthcare agenda, and his leadership has strengthened our will to bring that agenda to fruition. His Executive Orders – such as those dedicated to Medicare, kidney health, and price transparency – have challenged us to:

  • Reduce overly burdensome and unnecessary regulations;
    • We saved the medical community an estimated $6.6 billion and 42 million hours of burden through 2021, returning them time and resources to devote to patients – not needless paperwork.
    • We eliminated 79 measures across quality payment programs in the hospital setting, inpatient psychiatric facilities, ambulatory surgery, cancer hospitals, and hospital outpatient departments through the Meaningful Measures initiative. This resulted in projected savings of $128 million and an anticipated reduction of 3.3 million burden hours.
  • Expand price transparency across the healthcare delivery system by finalizing policies that make hospital prices more transparent, and proposing additional policies for insurance plans to disclose price and cost-sharing information up front, so patients are more informed about costs;
  • Strengthen the individual health insurance markets by issuing regulations and guidance that increase competition, expand choice, and give states more flexibility to innovate their own solutions to improve their markets;
  • Step up our efforts to keep fraudulent providers out of our program: in 2019, we took administrative action against 130 companies that claimed over $1.7 billion for medically unnecessary back, shoulder, wrist and knee braces and suspended 11 laboratory providers who billed Medicare for more than $2.1 billion in medically unnecessary cancer genetic testing;
  • Add 11 new procedures that Medicare can pay for in the hospital outpatient setting when previously only paid for in the hospital inpatient setting, giving patients the choice to go home after a procedure;
  • Propose the new ESRD Treatment Choices Model to improve kidney care
  • Streamline the innovative medical products process by providing alternatives for new technology add-on payment (NTAP) pathways in which Breakthrough Devices are no longer required to demonstrate evidence of “substantial clinical improvement” to qualify for an NTAP.
  • Release for the first time a robust repository of research-ready Transformed Medicaid Statistical Information System (T-MSIS) data files. Now, researchers and others can answer questions about Medicaid and CHIP enrollment, services, and payment; and
  • Propose the first comprehensive update to Medicaid’s fiscal regulations in decades to ensure dollars support patient needs and taxpayer resources are appropriately protected.  

We’re already seeing tangible results. Average Medicare Advantage premiums are lower, and plan choices for beneficiaries increased after we implemented policies to strengthen negotiation and maximize competition. 1,200 Medicare Advantage plan options have been added since 2018, and premiums have gone down 23 percent from 2018 to their lowest level in 13 years. For the third year in a row, the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, is projected to decline. Over the past three years, average Part D basic premiums have decreased by 13.5 percent, from $34.70 in 2017 to a projected $30 in 2020, to their lowest point in seven years. This has saved beneficiaries about $1.9 billion in premium costs over that time.

That’s real money in people’s pockets, and we’re seeing similarly positive results from our efforts to strengthen the individual market.  In 2020, average premiums for plans sold on HealthCare.gov dropped for the second consecutive year.  At the same time, the number of issuers participating on HealthCare.gov increased by 20, bringing the total of new issuers to 43 since 2018.

While the results speak for themselves, much remains to be done. We at CMS are determined not to rest on our laurels but to bring the work of the agency to even greater heights. Our goal is to continue lowering the cost of healthcare, which remains too high for so many Americans; to increase access for vulnerable populations; and to ensure the sustainability of our programs, so they remain a lifeline for future generations. Stay tuned for more in 2020. Our work has only just begun.


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