With each new administration, the head of the Centers for Medicare & Medicaid Services (CMS) faces challenges left behind from legacy teams and processes. In 2021, however, the challenges are that much greater due to the COVID-19 pandemic, dramatic policy shifts made by the previous administration, and the coming Medicare insolvency threat.
Chiquita Brooks-LaSure has been nominated as the new CMS administrator under President Biden - once confirmed, there are a few key challenges that will likely take top priority for her and her team to establish a forward-looking agency while addressing a legacy of challenges and pressures.
1. Imminent threat of Medicare insolvency
The most immediate challenge, especially in the wake of the COVID-19 pandemic, will be the imminent threat of Medicare insolvency. In September 2020, the Congressional Budget Office (CBO) issued a worrisome outlook on the solvency of the Hospital Insurance (HI) Trust Fund, forecasting the HI fund would become insolvent by 2024, a full two years sooner than originally forecast by an April Medicare Trustees report.
The reasons for the drastic change include the continued enrollment of the baby boomers and reduced Medicare payroll taxes due to the pandemic's impact on the economy. The new CMS administrator can target a few key, tactical areas to help restore longer-term solvency.
Targeting high-cost care
A number of health conditions carry a large weight on the Medicare budget, such as sepsis, clostridioides difficile (C.diff), and other healthcare-associated infections. In 2020, Health and Human Services reported a 40% increase in Medicare beneficiaries hospitalized with sepsis from 2012 to 2018, and the condition cost more than $41.8B in 2018 alone. By identifying solutions to mitigate these conditions – especially preventable ones – CMS can help relieve long-term Medicare costs.
Accelerating value-based care
The CMS can accelerate technology and data-based innovations to increase value-based reimbursement adoption and promote evidence-based care through groups like Accountable Care Organizations (ACOs) to avoid unnecessary and wasteful medical procedures and testing. Medical communities could receive incentives by improved outcome reporting and creating innovation in processes or technology.
Additionally, focusing on digital models for more effective opioid stewardship and clinical surveillance for hospitals can help administrators understand how to target assistance and provide additional resources and incentives to mitigating long-term costs.