On November 8, 2016, Donald Trump was elected to occupy the Oval Office as the 45th president of the United States while Republicans maintained control of both the U.S. House and Senate. For healthcare C-suite leaders, this administration shift brought with it new policy implications to consider in both the short- and long-term.
Now a few months into Trump’s presidency, Healthcare Informatics readers still have a myriad of questions as uncertainty lingers over the future of healthcare policy. As such, our editorial team concluded that the value-based healthcare landscape, within the current policy moment in the U.S., was well worthy of being one of Healthcare Informatics’ Top Tech Trends for this year. Within this trend are several moving parts, which could change at any point; but for health IT leaders, some of the key policy points to consider are:
- The leadership positions at two healthcare federal agencies are likely to bring with them much different mentalities than what was seen in the previous administration. Recently-confirmed Health & Human Services (HHS) Secretary Tom Price, M.D. and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma will emphasize de-regulation and putting more decisions in the hands of doctors and patients, rather than the federal government. Both Price and Verma have talked about this in recent Senate hearings.
- The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was passed with bipartisan support, seems safe. MACRA launched its first reporting period in January 2017 in which eligible Medicare clinicians will be reporting to a Quality Payment Program that determines a physician’s reimbursement based on the high quality, efficient care they provide that’s supported by technology. The MACRA law was enacted in order to sunset the constant “patches” to the never-funded SGR (sustainable growth rate) law; that means that any overturning of MACRA would require Congress to re-fund what could be more than $250 billion that would have to be recouped—an immense amount of federal funding that would pose challenges for anyone considering repealing MACRA.
- Other value-based purchasing and accountable care payment programs have a bit of a murkier picture. Accountable care organizations (ACOs), many of which were stemmed from the very Affordable Care Act (ACA) that Trump is trying to “repeal and replace,” have their share of skeptics. Meanwhile, Secretary Price has been outspoken in the past on not forcing providers—especially physicians—into bundled payment programs.
- Overall, there has been a strong desire from the new administration to reduce the burden that health IT puts on doctors. This was also a priority of the prior administration’s federal healthcare leaders, but coupled with the objective of Trump and his cabinet to de-regulate, it carries more teeth this time around.
- The future role of the Office of the National Coordinator for Health Information Technology (ONC), the federal government’s health IT arm, also is cloudy. While no one expects the agency to be dismantled, the administration will have to name a new National Coordinator for Health IT at some point while current ONC staffers wait for more direction. The ONC might also see major funding cuts, based on priorities of the new administration.
Different industry experts will have varying opinions on all of the above, but the sources interviewed for this story all agree on one broad concept: value-based healthcare will continue to march on. Jeffrey Smith, vice president of public policy, at the Washington, D.C.-based American Medical Informatics Association (AMIA), expects new senior federal healthcare agency officials to conduct a broad review of initiatives that are ongoing or fairly new. “I am anticipating perhaps a consolidation of a lot of work going on at CMMI [the Center for Medicare & Medicaid Innovation] and with it, potentially an opportunity to look at some of the drivers that have historically been plaguing documentation burdens,” says Smith. Indeed, CMMI has been a target of Republicans in the House in the past, who say the center, which was established as an added section of the ACA, has overstepped its definition in statutes. Brian Ahier, digital health evangelist at Salt Lake City, Utah-based Medicity, predicts that CMMI, “which many in Congress feel has not been accountable enough for the funds [they have received], will ultimately be defunded.”
As for the future of ACOs, Smith says that it’s “incredibly unlikely that any ACA repeal would include something like the [elimination of] the Medicare Shared Savings Program [a federal ACO model]. I say that because when you look at the balance sheet, the MSSP is not costing the government a lot of money and it is starting to pay dividends for those who have been in [the program] for a while.” Smith adds that there has been a big push to lower the bar for entry, in terms of what is defined as “nominal cost” for a qualifying alternative payment model (APM) under MACRA, “so you will see a push to make investments into having an ACO count as the [required] nominal cost. Whether or not HHS looks at that and will actually count it, well, that doesn’t look good on paper,” he says.