New CMS Initiative Cites Need for Competition in Healthcare Industry

Projects 20 percent of U.S. spending will be healthcare related by 2027

The Centers for Medicare & Medicaid Services (CMS), released an update on the administration’s #PatientsOverPaperwork initiative, citing the need for competition in the industry.

But some home medical equipment (HME) providers weren’t convinced.

“By 2027, nearly one in every five dollars spent in America is projected to be spent on health care,” said administrator Seema Verma. “To address this issue, it is important to first understand the factors behind this trend. A recent study in JAMA showed that healthcare utilization is not significantly different between the US and comparable countries, but prices are much higher in America.”

Verma said that certain government policies have limited competition and driven health care consolidation, including regulations enacted by CMS. “The costs to comply with CMS regulations have, in many cases, become too high for small, independent physicians to bear—from requirements regarding EHRs to new regulations under MACRA—forcing them to become employees of hospitals.”

Patients Over Paperwork is an initiative to update regulations that are outdated, duplicative or overly burdensome. The agency is also promoting price transparency as a means to bring competition to the health care market and provide patients with more options. Currently, the initiative applies only to hospitals and the regulatory burdens physicians face.

Because of this, Verma’s remarks fell hollow for HME providers. Tyler Riddle, CEO of MRS Homecare, Inc. in Tifton, GA, said in a tweet, “Many, if not all, ancillary care services rely on the paperwork created by (CMS) for reimbursement. Without reams of paperwork and documentation created by physicians we are unable to bill for our services.”

HME providers are subject to delivery requirements, physician documentation, prior authorization, and other burdensome regulations. The industry has also felt the burden of competitive bidding in recent years, set to restart with Round 2021 this month.

SOURCE: HomeCare

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