Mehmet Oz, MD, the TV doctor and one-time Senate candidate, recently was confirmed by the very body he once hoped to join to lead the Centers for Medicare and Medicaid Services, or CMS.
As its name states, CMS oversees Medicare and Medicaid, two federal healthcare programs that together provide care for 145 million people. Medicare mostly covers people 65 and over, while Medicaid is oriented toward lower income households, children, the disabled and pregnant women.
“In a nutshell, what the agency does is set the payment rate that go to the hospitals, doctors and other healthcare providers for the services they provide [to enrollees],” said Nick Hut, senior editor for the Healthcare Financial Management Association.
CMS also sets policies around payment rates, under guidelines set by Congress.
One of the biggest issues facing CMS is how to treat the fast-growing, privately sourced aspect to Medicare called Medicare Advantage (MA). Until recently, MA was the golden child of CMS, attracting millions of Medicare members who were eager to take advantage of the many benefits offered through these plans. But it turns out that the MA’s offerings for wellness, such as gym memberships, cost a lot of money, and insurers running the program were accused of overstating the degree of ill health its members had, which, if true, would result in overpayments to the insurers.
And there’s kind of a tug of war going on in the Trump administration between fans of Medicare Advantage and those eager to remove wasteful spending.
“[Some officials] think it’s the best way to administer Medicare, through these private insurance plans,” Hut said. “But the administration is also keen to crack down on wasteful spending across the government and Medicare Advantage.”
In an early sign as to which way the administration is leaning, CMS announced it would be boosting payments to MA insurers more than 5% on average, which is more than double the increase proposed by the Biden Administration.