CMS Administrator Dr. Mehmet Oz is optimistic about Washington’s ability to bend the health care cost curve, he said during a speech Tuesday at the HFMA Annual Conference in National Harbor, Maryland.
“It’s not all rosy, but there are opportunities. As a clinician, I tell you, if you have the opportunity to solve a problem, it gives you more hope than if you think the problem is terminal. We’re certainly not terminal,” he said.
During his speech, Dr. Oz highlighted some key areas CMS is targeting to make health care more affordable. Below are the main pillars of the agency’s affordability program.
Fraud, waste and abuse
Eliminating fraud from the Medicare program alone would double the life of the trust fund without raising taxes, Dr. Oz argued.
He cited examples of large-scale fraud cases that the federal government has cracked in recent months: an outsized number of durable medical equipment suppliers in South Florida, a disproportionate share of the nation’s hospices concentrated in Los Angeles, and inflated employment in personal care services in New York and California.
“A lot of this started during Covid, because what we taught the fraudsters during Covid is that we’re going to give a lot of money to the federal government, and we don’t really have a way to track it, so we can’t really tell if you used it the right way, and we can’t get it back if you don’t. Because of that, we brought a lot of people into the health care ecosystem who had never thought about defrauding health care before – but now that they know it’s possible, they like it,” Dr. Oz remarked.
Drug price reform
Dr. Oz highlighted the Most Favored Nation Pricing Initiative, which requires pharmaceutical companies not to charge Americans more than what developed countries pay abroad. He projects that this policy will result in savings of $600 billion over 10 years.
He also noted that Medicare beneficiaries with obesity-related illnesses will be able to access GLP-1 drugs for $50 per month from July 1.
Technological modernization
CMS is replacing Medicare’s COBOL-based billing system with a cloud platform, marking the first upgrade in more than 50 years. Dr. Oz said this change would speed up the way Medicare processes and adjudicates claims.
He also noted that CMS had launched its Medicare App Library in April, which aims to create a more consumer-focused and application-based health data infrastructure.
As part of this initiative, patient data does not remain siled in individual applications. Instead, participating companies connect to CMS-backed data sharing networks – including health information exchanges and interoperability frameworks – that enable data to flow directly into clinician workflows. Nearly 800 health technology companies have signed on to the initiative, Dr. Oz said.
Preventive health and nutrition
The country’s high burden of chronic disease – particularly obesity – has a huge impact on rising health care costs, Dr. Oz noted.
To help address this problem, CMS is working to integrate nutrition education into medical school curricula. Dr. Oz noted that more than 50 schools have committed to providing 40 hours of nutrition training.
“The problem is we don’t teach people in training about things like nutrition, so they don’t think it matters. It turns out that if you want to deal with chronic diseases that account for at least 70 percent of all health care costs, you have to be able to address the basic realities of preventative medicine, including nutrition,” he noted.
Dr. Oz also cited the recently revised food pyramid as a significant step toward correcting decades of flawed dietary advice that he says has contributed to the obesity crisis.
Deregulation
Under a White House executive order, CMS must eliminate 10 regulations for every new regulation introduced.
Dr Oz said he welcomed the mandate. He argued that much of the current quality measurement apparatus creates administrative burden without actually improving care.
“Not everything that can be measured matters, and not everything that matters can be measured,” he said.
Photo: Katie Adams, MedCity News
