Perhaps even more than some years, 2014 has been a year filled with surprises, big and small, in U.S. healthcare. And some surprising healthcare policy developments were particularly worth noting.
Surprises are what keep us on our toes, right? Well, that certainly has applied to this year. Among the top surprises that have affected healthcare leaders this year:
- On March 31, the U.S. Senate passed another temporary Sustainable Growth Rate (SGR) “doc fix” bill, just hours before automatic, 24-percent Medicare physician payment cuts were set to go into effect. That bill, which President Obama signed, contained a big surprise, the form of a 12-month delay to the October 1, 2014 deadline for a mandatory transition to using the ICD-10 coding system on the part of providers and payers. What became clear in subsequent weeks was that lobbyists representing organized medicine had slipped the clause about ICD-10 into an otherwise-unrelated piece of legislation. Not that that development was in any way unprecedented; indeed, it is common for federal legislators to insert a wide variety of clauses unrelated to core bills into those bills, at the last moment. But this clause completely upended one policy-driven process in healthcare. And industry observers are predicting that yet another delay could happen, though Health and Human Services officials have taken pains to reassure providers and payers that no further delays will occur. (Then again, how can they be sure…?) Indeed, what made this development particularly surprising was that, just one month earlier, Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner, R.N., had announced “no delays,” in an appearance at HIMSS14, the annual conference of the Healthcare Information and Management Systems Society, held in Orlando. Of course, Tavenner had no idea at that time what would happen in Congress just a month later.
- Throughout the summer, the Office of the National Coordinator for Health IT (ONC) saw one departure after another among its senior officials, including Joy Pritts (June 12), Lygeia Ricciardi (June 26), Doug Fridsma, M.D. Ph.D (Sep. 22), Judy Murphy, R.N. (Oct. 3), and Jacob Reider, M.D. (Oct. 24). By the time that Secretary of Health and Human Services (HHS) Sylvia Mathews Burwell announced on Oct. 23 that Karen DeSalvo, M.D., National Coordinator for Health IT, had been tapped to serve as Acting Assistant Secretary for Health in order to support the White House’s Ebola response effort, it felt as though ONC had largely been cleared out at the highest levels, as I wrote in a November 4 blog entitled “Mass ONC Departures: Are the Lights On With Nobody Home? Five Critical MU Questions Federal Health Officials Must Answer.” Could anyone have anticipated so many senior-level departures from ONC in one year? Perhaps someone theoretically could have predicted the wave of departures; but no one did.
- And of course, the DeSalvo not-quite-departure was yet another surprise. Not because Dr. DeSalvo was unqualified to lead an Ebola management effort; indeed, she was eminently qualified, having been the City of New Orleans Health Commissioner prior to being chosen as National Coordinator. What was surprising was that, at a time when ONC had already been hit with a series of departures of senior officials, that the agency’s most senior official was semi-leaving to help manage that initiative. As I and others asked at the time, how did federal officials expect to manage and guide the meaningful use process under such conditions?
- But then, just days later, ONC, in an unsigned blogpost on Oct. 29, “clarified” that Dr. DeSalvo was going to continue in her role as National Coordinator while also directing the Ebola response team. Highly placed sources shared with me at that time that senior-level officials at HHS and CMS were shocked by the taken aback by the public outcry over Dr. DeSalvo’s stepping away from ONC at a time of intensifying needs for close management of the meaningful use program at a critical juncture in its evolution.
- Meanwhile, in another policy galaxy, 2014 was a year of ups and downs for the Pioneer ACO Program and the Medicare Shared Savings Program for ACOs, the two federally sponsored programs for accountable care organization development. While some data released in the fall indicated positive trends, other data was more mixed or even worrisome. As I wrote in a blog in early October, it was a classic “glass-half-empty, glass-half-full” situation. Some data was surprising, some was worrying, some was mildly uplifting.
- In fact, the sudden departure of Sharp HealthCare’s ACO from the Pioneer ACO Program during the summer (though that departure was not revealed until the beginning of September), 10 of the original 32 Pioneer ACOs had left the Pioneer program, either shifting to the MSSP program or leaving federal ACO participation altogether. The Sharp departure certainly marked a low point for CMS in that area during 2014.
- But then, in a rather significant surprise, we learned on Dec. 22 that 89 new ACOs would join the MSSP program, bringing the total number of ACOs in that program to 405 (while 19 Pioneer ACOs remained in place). The total of all ACOs, beginning in January, will suddenly be 424, serving over 7.8 million beneficiaries, as Sean Cavanaugh, deputy administrator and director at the Center for Medicare, noted in a CMS Blog-based announcement. That announcement must have been a champagne—uncorker at the somewhat-beleaguered CMS.
So it’s been quite a year on the federal healthcare policy front—and these developments are only several of the many important ones that have taken place this year—but they certainly did involve some of the most surprising developments in 2014. Of course, there were numerous non-policy-related surprises, including the acquisition of most of Siemens Healthcare by the Cerner Corporation—but what seemed clear in 2014 was that policy was the major driver for so much of what happened this year. One can only imagine what 2015 will be like, as the meaningful use process rolls forward, elements of the Affordable Care Act intensify their impact on providers, and we finally (if indeed there are no further delays) transition to the ICD-10 coding system. Given all this, my mind immediately goes to the unforgettable line uttered by Bette Davis as the character Margo Channing, in the classic movie “All About Eve”: “Fasten your seatbelts, it’s going to be a bumpy night!”