With the stunning presidential election upset Tuesday night, Donald Trump will become the 45th president of the United States while Republicans maintained control of both the U.S. House and Senate. Indeed, the transition to a Republican administration and a Republican-controlled Congress come January will require the health IT industry to consider the short and long-term implications for healthcare policy and health IT-specific polices.
What are the prospects for healthcare legislation in Congress during the lame duck session? With a Republican-controlled Congress beginning in 2017, how will the landscape for legislative activity change? What will be President-elect Trump’s healthcare policy priorities and how will that impact health IT initiatives? Healthcare Informatics spoke with health IT industry associations and policy leaders Wednesday morning to get a sense of how the industry is assessing the impact of the election on healthcare policy and initiatives.
In the near-term, progress on health IT legislation, such as the 21st Century Cures Act, during the lame duck Congressional session will be a key focus, according to Tom Leary, vice president of government relations at the Chicago-based Healthcare Information and Management Systems Society (HIMSS).
“With the House and Senate maintaining Republican majorities, we have a pretty good sense of what their priorities were for this year and what will roll over into 2017. I think what we’re trying to reassess this morning is what will be the priorities during the lame duck and whether health IT and healthcare is part of it, or if a newer version of the Cures bill gets reintroduced in January 2017. As of yesterday, we were thinking it was primed to be moved in the lame duck in the Senate and then reconciled with the House and then to the President’s desk before the holidays, and we’re trying to reassess that today. So the next 48 hours or so will be telling for us,” he says.
He continues, “I do believe that the House and Senate are still are very much interested in ensuring the U.S. maintains its high level of superiority in biomedical research and the tenants of the Cures Act, whether it’s passed now or a newer version comes up in the new year, is really to keep the U.S. at the forefront of biomedical research, well into the 21st century. That’s bipartisan and bicameral, that’s a national priority.” He also expects a Trump administration and a Republican-controlled Congress will continue to move forward healthcare-related initiatives such as the Precision Medicine Initiative and Vice President Biden’s Cancer Moonshot.
There is a great deal of uncertainty about President-elect Trump’s specific healthcare priorities and policy platforms, yet during his acceptance speech early Wednesday morning, Trump promised to improve several aspects of the national landscape, including hospital infrastructure.
“We are going to fix our inner cities and rebuild our highways, bridges, tunnels, airports, schools, hospitals. We’re going to rebuild our infrastructure, which will become, by the way, second to none. And we will put millions of our people to work as we rebuild it. We will also finally take care of our great veterans,” Trump said during his victory speech.
Leary continues, “He’s [Trump has] also talked about telehealth for veterans in his speeches and last night in his victory speech, he talked about healthcare and hospitals, as part of restoring a strong infrastructure within the U.S. So I would anticipate that his telehealth for veterans is not just a veteran’s issue but that he’ll utilize telehealth as a way to address some of the access needs whether it’s rural or urban communities that could equally benefit from telehealth services.” And, he says, “The other thing we’ll be looking at, is what his stance is going to be on standards development and innovation? So we’ll be looking very closely at those types of issues.”
On the campaign trail, President-elect Trump also spoke about repealing the Affordable Care Act (Obamacare), which would mark a significant shift in healthcare policy, and would have some implications for health IT, Leary says.
“We know it’s not as simple as pulling the plug on the legislation,” Leary says. “Depending on the outcome of two seats that are still up in the air, it’s still a very tight Senate, so being able to pass a sweeping repeal of Obamacare may not be as simple, procedurally, as the campaign trail might lead people to believe. But I think most importantly, and it’s not necessarily a health IT component, but what is the solution that’s going to cover those 22 million that are now insured, keep them insured, in the new plan?”
When asked about the repealing of Obamacare, Jeffrey Smith, vice president of public policy at the American Medical Informatics Associations (AMIA), says that one of the things that will hit Washington D.C., at some point very soon—if it hasn’t happened already— is a “holy crap, we’re in charge now” realization on the part of Republicans. “What that will do is force people to move from talking points and get into the details of policy. They will find that this is an incredibly tightly wound ball of yarn and we cannot pull on one string and unravel it all,” Smith says.
Additionally on the potential repeal of Obamacare, Leslie Krigstein, vice president of congressional affairs, College of Healthcare Information Management Executives (CHIME), cautions folks to remember that the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act are two different pieces of legislation, which would keep regulations like Meaningful Use separate. “It would be very hard to just ‘turn it off,’” she says, referring to healthcare policies that are already baked in. “You also have tens of millions of Americans reliant on healthcare. But for health IT implications, it will cause a distraction,” she predicts.
Health IT Implications
With regard to healthcare regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA), Leary does not anticipate any fundamental changes under a Trump administration.
“From a health IT perspective, MACRA was passed on a very strong bipartisan basis to move us towards value-based reimbursement and care delivery, so I fully anticipate that the foundational needs of healthcare with respect to the needs of health IT—to be interoperable so that quality metrics can be reported and patient information on the right patient gets to the right provider at the right time—those are still going to be priorities in any changes to overall healthcare policy, so we really have to continue to deliver on making interoperability more and more of a reality,” he says.
Smith agrees with Leary that larger value-based federal healthcare programs such as MACRA won’t be significantly changed, though certain provisions of the law’s Quality Payment Program could be “re-envisioned” in what Smith predicts “could be a shift towards more de-regulation.” Smith says, “Government policy is traditionally meant to ensure that low performers and bad actors have a floor below which they cannot go. Regulation is generally meant to ensure that the bad actors and low performers are held accountable in a value-based world, and that the performers at the top are not encumbered. A Trump administration will provide a space for people to go back and look at things like the Quality Payment Program. So I could see a ‘rollback’ that would look at MACRA legislation and think about what the minimum necessary requirements are. And if those minimum necessary requirements are deemed too difficult, can they scale the program back some?”
There have been some contentious health IT-related legislative issues this past year, as Republicans in the House have attempted to defund the Agency for Healthcare Research and Quality (AHRQ) and have also been critical of the Center for Medicare & Medicaid Innovation (CMMI) for overstepping its definition in statutes. Will the election results have any likely impact on those organizations, or on funding for the Patient Centered Outcome Research Institute (PCORI)?
“AHRQ funding, from my understanding, is moving forward and last night’s maintenance of the Senate majority keeps AHRQ funding, fully funded, for this year, and I don’t anticipate the election outcome having a negative impact on AHRQ,” Leary says. “And, my sense is that the mission of PCORI is still very much recognized as being needed. The mission around patient-centered outcomes research, and outcomes research in general and its funding has been a bipartisan initiative since the 2003 Medical Improvement Act. It was the Bush administration and Republican Congress that got us started down that road of using outcomes research. So I think the idea of outcomes research helping to improve where we spend our precious healthcare resources will continue to be an important initiative funded by the government and by the private sector.”
Smith, however, says that the CMMI, AHRQ, PCORI, and the Medicare’s Independent Payment Advisory Board (IPAB) are “huge targets.” He says, “For those of us who know what those acronyms stand for, we know they would be big losses.” That’s why, Smith adds, that in the beginning, conversations will have to be about “using only primary shapes and colors.” He explains, “We will have to educate people who have very little understanding for the complexity of the world in which we live in. And that’s not a unique challenge; it happens anytime you get someone new who comes in. Intelligent and well-intentioned people have come in [to the White House] and said, ‘Wow, this is a much bigger challenge than I anticipated.’”
Smith adds that one of the biggest questions for him going forward is what the “brain drain” will look like at federal agencies such as the U.S. Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC). “Any time there is a transition there is a brain drain which includes thousands of political appointees below the cabinet positions too,” he says. “I just can’t imagine a more stark contrast between most of Obama’s Cabinet and political appointees and what will be Trump’s Cabinet and political appointees. It’s not at all clear to me that the same talented and intelligent people will turn up for the job,” Smith says, adding that HHS Secretary Sylvia Mathews Burwell is “a technocrat who understands the complexities and how difficult change is.”
But in the end, Krigstein attests that “health IT is here to stay.” She says that health IT issues have largely been bipartisan, specifically noting a desire from both political parties to: sendoff cybersecurity threats more in the future than today; make sure there is a digital infrastructure to support decision making from clinicians and to empower change; and to continue efforts to dive into usability and optimization of electronic health records (EHRs). “I don’t see many health IT surprises in this space, as there is a recognition that patients and clinicians alike are empowered with the use of technology,” Krigstein says.
To this end, the Charlotte, N.C.-based Premier, Inc. released a statement on Wednesday that said the organization is “looking forward to working with President Trump and the Republican Congress on healthcare transformation.” The statement further said, “There is a great deal to be done to transform healthcare. At the top of the list is achieving interoperability of health IT systems, specifically EHRs, which we encourage Congress to address in the upcoming lame duck session. We also believe more needs to be done to incent providers to move to alternative payment models, such as accountable care organizations. This can be accomplished by eliminating cumbersome and antiquated regulations, reducing the level of risk required in establishing these models, and ensuring competition by creating a level playing field for all healthcare providers seeking to enter these models.”
Moving forward, Krigstein still maintains that there will be a continued drive to improve outcomes. “Regardless of power and party, there is a recognition that there is an opportunity to improve healthcare, and the [government] will still be budget conscious, so I think those sorts of efforts will stick around. We just need more details in place,” she says.