Voices: A Q&A with Medicare's top official Chiquita Brooks-LaSure.

Administrator Chiquita Brooks-LaSure joined me a highly informative conversation.

Medicare and Medicaid account for $1.6 trillion of spending every year. That chunk of change is wrangled by the Centers for Medicare and Medicaid Services (CMS), an agency within the US Department of Health and Human Services. Effectively, the CEO of that operation is the CMS “Administrator,” currently Chiquita Brooks-LaSure. As such, Brooks-LaSure is one of the most powerful people in healthcare, especially given that CMS has enormous regulatory authority over hospitals in the United States. CMS dictates a lot, from reimbursement rates to physicians to quality metrics that hospitals must follow (unless they want to fail an inspection).

Last week, Administrator Brooks-LaSure and I had a wide-ranging discussion for MedPage Today, and I want to share that with you. The video of our conversation comes in two installments. Here are some highlights and links to both Part one and Part two of the interview.

Part one highlights:

• Open Enrollment for Medicare, Medicaid, CHIP (Children’s Health Insurance Program) and the Affordable Care Act (“Marketplace”) coverage: These programs cover a significant portion of the US population. Brooks-LaSure highlighted efforts being made to reach out to people so that they receive their benefits. Open enrollment for the ACA marketplace began November 1st and goes through December 15th.

• Medicare prescription drug changes: The Inflation Reduction Act (a recent win for the Biden administration) stands to make prescription drugs more affordable for beneficiaries, in part because the government can now finally negotiate prices with drug companies.

• Physician Participation: Cuts to physician compensation for Medicare and Medicaid mean that more doctors might opt out of accepting these forms of insurance. I asked how access can be expanded if doctors are being disincentivized from participating.

• Coverage Decisions: CMS makes coverage decisions. We discussed controversial Alzheimer's disease drugs Aduhelm and Leqembi; Aduhelm was recently FDA-approved (a highly criticized move) but CMS said “no thanks” to covering it. Leqembi is both approved and covered by CMS. We dove into why this matters.

Part two highlights:

1. Medicare Advantage growth and marketing: Medicare Advantage (MA) plans were discussed. MA plans are supplemental insurance plans meant to resemble employer-sponsored options. But there have been problems, with some plans falling short, and some predatory marketing. Administrator Brooks-LaSure emphasized the importance of making sure Medicare beneficiaries are well-informed about what’s out there, and protected from scammy products.

2. Infection control and safety: We then discussed nursing home and hospital safety, with a focus on infection control. The impact of infection control measures during the Covid-19 pandemic should be an object lesson for the future. We discussed the role CMS has in regulating safety and quality in healthcare facilities (hospitals, nursing homes), particularly during flu season and respiratory pathogens.

3. Boarding in emergency departments: I raised the problem of "boarding," where patients remain in ERs due to a lack of available inpatient hospital beds. Boarding leads to poorer care and strains ER staffs, sometimes threatening patient safety. I asked how CMS could get more involved in addressing this growing issue.

4. Telehealth and CMS’s sepsis regulation: We ended by touching on CMS’s support for telehealth services (including for opioid replacement therapies like buprenorphine, as discussed in a recent Inside Medicine) during the pandemic. Additionally, I brought up CMS’s sepsis regulation (SEP-1) which experts (including the Infectious Diseases Society of America) have asked be retired in favor of something better.

Here are those links again: Part one, Part two.

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