US Senators urge CMS head Verma to include med device ID on claims

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Centers for Medicare & Medicaid Services (CMS)

Two US Senators this week wrote to Centers for Medicare and Medicaid head Seema Verma urging her to add a field for unique medical device identifier information on insurance claim forms.

The letter, from Senators Elizabeth Warren (D-Mass) and Chuck Grassley (R-Iowa), cited a report from the Department of Health and Human Services’ Office of Inspector General from September.

The report claims that nearly $1.5 billion in costs to Medicare came from patients treated with seven specific cardiac devices from 3 manufacturers that were recalled or showed high failure rates over a 10 year period.

The OIG release also claimed that the defective items led to an estimated $140 million in copayment and deductible liabilities for beneficiaries.

“To facilitate the use of claim data to identify and track the additional health care costs incurred by Medicare from recalled or prematurely failed medical devices, we specifically recommend that CMS: (1) continue to work with the Accredited Standards Committee X12 to ensure that the Device Identifier is included on the next version of claim forms and (2) require hospitals to use condition codes 49 or 50 on claims for reporting a device replacement procedure if the procedure resulted from a recall or premature failure independent of whether there was a device provided at no cost or with a credit,” the OIG wrote in its report.

In their letter, Senators Warren and Grassley wrote that they were “encouraged” by CMS head Verma’s statement after the OIG report which stated that the addition could help CMS “more effectively identify and track Medicare’s aggregate costs related to recalled ore prematurely failed devices, reduce medicare costs by identifying poorly performing devices more quickly, facilitate device recipients’ chances of receiving timely follow up care, and protect beneficiaries from unnecessary costs.”

The Senators cited, however, that CMS chief medical officer Kate Goodrich did not confirm whether CMS would take the recommendations of the OIG during testimony before the Senate Committee on
Health, Education, Labor, and Pensions.

In response, Senators Warren and Grassley directly requested that CMS head Verma respond directly to three questions, including whether CMS supports capturing unique device IDs for implantable devices on claim forms. Senators also requested clarity on whether CMS follows recommendations from the HHS OIG and MedPac and is working with the Accredited Standards Committee X12 to “ensure that the DI is included on the next version of claim forms” and what, if any timeline CMS has for it’s ‘review’ of DI inclusion on claims forms.

Value-based care: CMS’s new administrator wants more of it

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CMS Seema-Verma

Seema Verma, CMS’s administrator

Seven months into her tenure, CMS administrator Seema Verma is turning out to be highly supportive of value-based care models. In fact, she recently told an audience in Cleveland that she wants them implemented faster.

The situation appears to dispel doubts that alternative payment models – such as Accountable Care Organizations or “comprehensive care” models for such big-ticket items as joint replacements – would remain a priority under President Donald Trump’s administration. The move toward paying for “value” versus the old fee-for-service models are a big deal for the medical device industry, which have been shifting their strategies and focus in response.

Alternative payment methods are important for driving innovation and driving value and cost-effective care, Verma said during an appearance at the annual Cleveland Clinic Medical Innovation Summit, which took place Oct. 23–25 in Cleveland. Different models will help drive the market toward value and quality and away from a fee-for-service system, according to Verma, who shared the stage with Cleveland Clinic CEO Toby Cosgrove.

Get the full story on our sister site, Medical Design & Outsourcing.

Trump proposes deep cuts to Medicaid, NIH funding

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Capitol HillPresident Donald Trump’s proposed budget would slash Medicaid funding and cut support for major biomedical research programs at the National Institutes of Health and the Centers for Disease Control & Prevention.

The budget blueprint drew condemnation from healthcare advocates and lawmakers from both sides of the aisle. Senate majority whip Sen. John Cornyn (R-Texas) reportedly said earlier this week that Medicaid cuts wouldn’t get through Congress.

“I think the tradition is presidents write budget proposals and that the Senate and the House substitute their own, and so I wouldn’t expect that would carry the day,” he told The Hill.

The potential $610 billion cut to Medicaid would add to the $839 billion cut proposed by the American Health Care Act that passed in the House earlier this month.

The proposal to slash Medicaid funding goes against Trump’s campaign promise to leave Medicaid, Medicare and Social Security funds untouched.

Among the more significant reductions proposed in Trump’s budget are an -19% cut to the National Cancer Institute and a -28% cut to spending on environmental health. The budget would also trim funding for the National Science Foundation by $776 million, or -11%.

According to the president’s proposal, the FDA would receive $1.89 billion in direct government funding. The 31% decrease would be offset by an increase of $1.3 billion in user fees.

Rep. Tom Cole (R-Okla.) said the proposed $5.8 billion cut to NIH funding “penny-wise and pound-foolish”, according to Stat. Cole is the chair of the House health appropriations subcommittee.

The proposal did not include any direct cuts to Medicare.

CDC director Dr. Tom Frieden took to Twitter to respond to the administration’s proposal, calling it an “assault on science.”

Also today, Rep. Tom Macarthur (R-NJ) resigned as co-chairman of the so-called Tuesday Group, a caucus of moderate House Republicans, citing divisions over efforts to repeal and replace former President Barack Obama’s healthcare law, according to a report from Politico. 

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