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Executive Order Directs HHS to Implement Market-Based Reforms to Medicare

For CEOs, government relations staff

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President Trump has issued an executive order instructing the Department of Health and Human Services (HHS) to pursue policies to strengthen the Medicare program “through alternative payment methodologies that link payment to value, increase choice, and lower regulatory burdens imposed upon providers.”

Specifically, the order encourages innovative Medicare Advantage (MA) benefit structures and plan designs, including expanded telehealth services. It also requires that Medicare fee-for-service (FFS) is not advantaged over MA.

Additionally, the order requires a report that will identify approaches to modify Medicare FFS payments to more closely reflect prices paid for services in MA and other commercial plans, as well as a separate study on recommending  approaches to transition “toward true market-based pricing” for Medicare FFS payments.

The order requires HHS to propose regulations within the next year to improve network adequacy for MA plans, reduce burdensome regulatory requirements for providers, ensure appropriate reimbursement to providers for time spent with patients, and conduct a comprehensive review of disparities in reimbursement between physicians and non-physician practitioners. It also requires continued policies to implement site-neutral payments, increase patient access to quality and cost data, and eliminate waste, fraud and abuse.