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BREAKING NEWS: House passes Cures Act, which now includes mental health funding, Senate passage is expected
Has the ACA Really Been Trumped?
President-elect Donald Trump has nominated Tom Price, MD, as U.S. Secretary of Health and Human Services. Both a surgeon and a congressman, Price seems as well qualified as anyone for the role. As an avid and tireless critic of Obamacare, Price has introduced alternative legislation in every session of Congress since 2009. The Empowering Patients First Act would effectively repeal the ACA and replace it with the following:
- Refundable, age-adjusted tax credits that individuals would use to purchase individual and family health insurance policies
- Ability to opt out of Medicare, Medicaid or Veterans Affairs benefits and receive the tax credit to buy an individual plan
- Incentives for people to contribute to health savings accounts
- State grants to subsidize insurance for “high-risk populations”
- Interstate commerce of insurance plans
- Association-style health plans for business/professional groups to provide insurance coverage
Some of Price’s other health-associated efforts have included supporting repeal of the Medicare SGR formula and adoption of MACRA, advocating for streamlined physician reporting requirements associated with value-based purchasing, and reigning in the authority of the Center for Medicare & Medicaid Innovation. His nomination to Secretary of Health and Human Services still must be confirmed by the Senate.
Will expediting cures come with unintended consequences?
According to Kaiser Health News, the 21st Century Cures Act is one of the most lobbied health care bills in recent history, with nearly three lobbyists working for its passage or defeat for every member on Capitol Hill. In real numbers, that’s 1,455 lobbyists representing 400 constituent organizations investing nearly half a billion dollars in less than a year. So what’s at stake?
The latest version of the bill (click here for a synopsis of the bill as passed by the House in July 2015) is one of those seemingly rare pieces of legislation to enjoy bipartisan support, probably because it has a little something for everyone. Highlights of the current bill include:
- Boosting NIH funding associated with brain, cancer and precision medicine research
- Increasing by $1 billion funding to address the opioid crisis
- Reducing the administrative burden associated with federal Health IT
- Expediting the FDA approval process for bringing new drugs and devices to market
While the first three are relatively non-controversial, the last one has a number of proponents and detractors. Underlying issues are transparency and accountability. Those in favor claim it will incentive more innovation, potentially decrease costs by bringing more treatment options to market, and ultimately benefit patients. Critics fear that the current bill will resurrect conflicts of interest that had been abated by the Sunshine Act, which also happens to be a provision of the ACA.
Is MACRA short for Macarena?
Like the 21st Century Cures Act, MACRA- the comprehensive rewrite of Medicare’s physician reimbursement model- enjoys exceptional bipartisan support. An acronym for the Medicare Access and CHIP Reauthorization Act (rather than a flashback to the 1990’s), MACRA will require providers to be smart about who their dance partners are. By design, it forces a progressive shift in physician reimbursement, similar to the volume-to-value shift already experienced by hospitals. This means that health systems must think carefully about their current and future physician alignment strategies and contracts.
Assuming MACRA’s rollout continues –and it most likely will, even under a new administration- physician payment will be increasingly at-risk as annual base payment adjustments flatline and any escalation will be tied to cost and quality metrics. So what does this mean for physicians, practice managers and their health system partners?
- Clinicians will need to redesign their practice models to better manage more complex patients.
- Practices will need to scale up their reporting efforts to support risk-based reimbursement (whether they choose MIPS or APM).
- Providers will need savvy suppliers and service partners to join their flash mob –specifically health technology and care management service companies that can automate reporting, provide predictive analytics and help manage patient risk.
With a new administration on the horizon, change is inevitable, but legislation with strong bipartisan support, like the 21st Century Cures Act and MACRA, are likely to continue moving forward. Worth noting is that any dismantling of the ACA could jeopardize them both. And because of that, changes to the ACA will most likely resemble a game of Jenga, rather than 52-card pickup, even with a Republican majority.
If you’re seeing other things in your crystal ball, please post your comments!