CLEVELAND -- Geraldo Rivera may not be an expert on value-based care, but he knows how to ask the hard-hitting questions. On Monday night during the Medical Innovation Summit, the Fox News Senior Correspondent broached the opioid crisis, rising drug costs and the lack of interoperability with CMS Administrator Seema Verma and Cleveland Clinic CEO Toby Cosgrove.

With the country facing a statistic of 90,000 deaths from heroin and opioid overdoses, President Donald Trump is on verge of declaring an opioid emergency, Rivera said.

"It is now the leading cause of death for people under 50," Verma said. 

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Rivera asked whether the proposed bipartisan compromise on the Affordable Care Act is good or bad.

"I can't understand why all Republicans think the ACA is terrible and all Democrats think it's great," Rivera said.

"I appreciate the goals of the ACA," Verma said, before outlining the law's drawbacks. 

The ACA did cover more people, she said, but most of those became covered under Medicaid, a program that was never meant to be public assistance for a lifetime for those not disabled or with special needs, she said.

[Also: Tech hurdles delaying flow of Medicaid data, impatient OIG says]

"The majority of people put in ACA were put in the Medicaid program," Verma said of Medicaid expansion. "We know one-third of doctors won't agree to see a Medicaid patient. We pulled people out of the public market and put them on a public program."

Verma also raised Iowa's inability to get a waiver to many of the law's mandates.

"I was talking to the governor of Iowa," Verma said. "The law is so inflexible, she was unable to get a waiver."

Iowa Governor Kim Reynolds announced Monday she would withdraw the state's request for a waiver to many of the ACA's mandates, calling the law too inflexible. Reynolds, a Republican called for a repeal and replacement to President Barack Obama's healthcare law.

States shouldn't have to ask for permission for a waiver, Verma said. States should have that flexibility.

But the main burden of the ACA is that it has done nothing to bring down healthcare costs, Verma said.

"The ACA did cover more people, it did drive up quality across the country, but it did not control the escalating cost of healthcare," she said.

Cosgrove said he would love to have the flexibility out of Washington but he doesn't want to see 50 different healthcare programs across the country and consumers moving to get better coverage.

"I hope to see will be a bipartisan approach to control the cost of healthcare," he said.

Cleveland Clinic has been working on volume-to-value to help control cost for nine years and has 500,000 lives at risk this year, Cosgrove said.

To help bring down the cost of healthcare for its own 50,000 employees, Cleveland Clinic stopped hiring smokers and offered free wellness programs such as Weight Watchers. It saw the cost of healthcare inflation drop by 2 percent. Copays went up by only 1.5 percent over the last four years and there was a 28 percent reduction in sick days. 

"We also lost 500,000 pounds," Cosgrove said.

Rivera asked what could be done about the high cost of drugs. 

Verma said CMS and the Food and Drug Administration, as well as folks in Congress, are looking at that.

Cosgrove said drug companies that raise the price of a drug by 500 percent in one year are bad actors and unconscionable. 

Then, a discussion on interoperability got personal, as Verma related a story of her husband going to the hospital after having a cardiac event in an airport.

Before he left the hospital, Verma went to get a copy of his medical records.

"He had lots of different tests," she said. "I asked, and they said they weren't sure what to say. They gave us a discharge summary and gave us a disk of one of the tests. I thought, here we are, this many years later, looking at paper."

Doctors are still faxing papers back and forth. This affects more than the cost of the records. It means duplicate tests are being done because there's no information being shared that the test has already been done, she said.

Asked by Rivera how to correct this, Cosgrove said, "I think this has to be mandated out of Washington." 

Cosgrove said telehealth helped his daughter address a rash on her forehead when he snapped a photo and sent it to a doctor who said it was poison ivy. 

"We're doing about 2,000 visits a month now," Cosgrove said of telehealth.

"It's a tremendous opportunity," Verma said. "To figure out, how can we support this. I think there's a way to do that."

Rivera also brought up Sen. John McCain raising the spectre of death panels to limit expenses.

Cosgrove dealt with the question of end-of-life care head-on, saying it is a problem that is not approached in Washington.

"We understand we would like to live with dignity and die with dignity," Cosgrove said. "In our profession, we extend life," he said, and not always to get a better quality of life but for sake of life itself.

Society must deal with this very emotional issue, he said.

"This is something people really don't want to speak about, talk about, it will not come out of Washington," he said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

Read our coverage of the 2017 Medical Innovation Summit in Cleveland.
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