Protecting and Improving Medicare for our Nation’s Seniors

On Thursday, October 3, President Trump issued an Executive Order (EO) on “Protecting and Improving Medicare for our Nation’s Seniors.”  While the EO does not provide legislative or regulatory specifications, it raises policy areas that the President believes need to be addressed to improve the Medicare program.

Briefly, the EO aims to expand enrollment in Medicare Advantage Plans to make them more attractive to seniors than the traditional fee-for-service program.  Within one year, the Secretary of Health and Human Services is asked to propose regulations and implement other administrative actions to provide more diverse and affordable MA options for seniors, by:

• Encouraging innovative MA benefit structures and plan designs, including better use of MSAs by seniors;
• Including a payment model that allows MA beneficiaries to share more directly in program savings;
• Ensuring that fee-for-service Medicare is not promoted over MA;
• Issuing a report within 180 days that identifies approaches to modifying Medicare fee-for-service payments to more closely reflect prices paid in MA and commercial insurance markets;
• Adjusting network adequacy requirements, including potentially greater use of telemedicine services;
• Proposing reforms to Medicare to allow providers to spend more time with patients, addressing areas such as conditions of participation, supervision requirements, licensure requirements, addressing disparities in reimbursement between physicians and non-physicians, and other issues.

Other policy proposals raised in the EO of interest include:

• Streamlining the approval, coverage, and coding process so that innovative products are brought to market faster.
• Ensuring that Medicare payments and policies encourage competition and a diversity of sites for patients to access care (site neutrality).
• Studying the use of various alternative payment and competitive bidding approaches, including use of MA-negotiated rates to set fee-for-service rates.

Several issues mentioned in the EO raise concerns, including possible reduction in physician payments and expansion of scope of practice.  The AMA will actively engage with Federation organizations and with the Administration about the EO and will provide significant input into the regulatory process as work on these policy proposals progresses.