Updates from Washington
By Cora Butler, JD, RN, CHC, President and CEO, HealthCore Value Advisors
It was January 20, 2017, when Donald J. Trump, the 45th President of the United States was sworn in, and the focus of what might be expected in the “First 100 days of a Trump administration” was unveiled. Within the first few hours of his presidency, Trump signed the executive order which pledged to repeal and replace of the Affordable Care Act (ACA). The fate of ACA wavered each day while the health care world voiced concerns about what to expect. It took the Republican leaders just 8 weeks to propose the so-called “Repeal and Replace” plan, known as The American Health Care Act (AHCA). However, seven years of Republican efforts to eliminate Obamacare seemed to end quickly, as increased opposition from not only the Democrats, but also within the Republican caucus resulted in the withdrawal of AHCA. Does this mean Obamacare is safe? Has the roller-coaster of the American Health Reform halted? Will Trump-Ryan duo revisit the push for healthcare reform, or let it go? Questions like these and many more continue to worry providers and divert their attention from patient care.
Although for the moment, the Republican bill seems dead changes to the current policies are sure to come. Former U.S. Senator Tom Price, an orthopedic surgeon from the suburbs of Atlanta, and now the confirmed Secretary of the Health and Human Services; is a staunch opponent of The ACA. While a Senator, he introduced the Empowering Patients First Act, with a focus on shifting control of healthcare from the government to patients and doctors and empowering states to innovate. Moreover, he shunned the rapid move through initiatives by the Centers of Medicare and Medicaid Services (CMS) and Centers of Medicare and Medicaid Innovation (CMMI) towards value-based care, and disapproved the idea of paying doctors based on quality and outcomes. As the newly appointed HHS Secretary, Price oversees the implementation of the CMS initiatives, some of which are still proposed rules. Given his stated opinion that many of the initiatives, such as bundled payments, “overhaul major payment systems, commandeer clinical decision-making, and dramatically alter delivery of care”, it is anyone’s guess how he will proceed.
The CMS Administrator Seema Verma, also confirmed, resonates the Price ideology of freedom being given to the states to innovate in their Medicaid programs. Verma, the architect behind the Healthy Indiana Plan (aka HIP 2.0), introduced that state’s version of Medicaid expansion which emphasized personal responsibility for enrollees. Under HIP 2.0, enrollees were either rewarded for making monthly payments and receiving preventive care, or penalized if they failed to do so. She criticized the Medicaid program under ACA, calling it “rigid, with complex rules that do not foster efficiency, quality or personal responsibility”. After leading the design of Indiana Medicaid reform, she consulted with Iowa, Ohio, Kentucky, and Tennessee on their Medicaid reform efforts during which she repeated the same themes. Absent the repeal and replacement of ACA, it will be interesting to see how she translates what she termed a “harsh” model nationwide.
Amidst the increasing complexity of the health reform, the stakeholders of Medicare Access and CHIP Reauthorization Act (MACRA) are struggling to distinguish its fate as compared to that of The ACA. Should primary care practitioners and specialists continue to track and report quality metrics? Or should they wait to see what evolves? The advice most frequently given is stay on track with the MACRA requirements. Reason being, the 392-37 vote in the House of Representatives reflects a strong bipartisan agreement for the move from volume to value. The absence of any reform initiatives specifically related to MACRA suggests that it is here to stay for the foreseeable future. This means that the recommendation is if your practice hasn’t yet started to come into compliance with the Quality Payment Program, as the MACRA requirements are known, the time to start is NOW to avoid negative payment adjustments and potentially benefit from positive payment adjustment opportunities.