Editor's note: The following is an edited excerpt of the transcript of a Jan. 12 editorial webcast, “What to Expect From Washington,” conducted by Modern Healthcare. The three panelists discussed the prognosis for reform in the year ahead and potential legislative and regulatory changes under a divided Congress. The panelists were Richard Pollack, executive vice president for advocacy and public policy at the American Hospital Association; Michael Tuffin, executive vice president of America's Health Insurance Plans; and Dr. Cecil Wilson, president of the American Medical Association. Modern Healthcare Washington Bureau Chief Jessica Zigmond moderated the webcast. The transcript of this webcast is sponsored by MedeAnalytics. Per editorial policy, sponsors are not involved in the development or publication of editorial content.
The year ahead in healthcare reform
Panelists discuss predictions and possible changes in Washington
Jessica Zigmond: Rick, in your remarks, you talked about implementation of the Patient Protection and Affordable Care Act as a major challenge this year. What part of the Affordable Care Act has had the most impact on hospitals to date?
Richard Pollack: In many respects, we haven't really seen the implementation of it take place yet. Perhaps the first reg that affects us in a direct way is the value-based purchasing issue. I don't want to negate the issues around the state exchanges ... but for us, in regard to the hospital world specifically, we're beginning to see that rollout. The value-based purchasing and the impending accountable care organization rules will probably be the first ones to watch.
Zigmond: Dr. Wilson, you mentioned that the AMA supports significant changes that you think are needed to the Independent Payment Advisory Board. Can you lay out some of those for us?
Dr. Cecil Wilson: One of the major concerns there is that as the IPAB is set up, it actually, in terms of its authority, primarily relates to reducing payments for care. We believe there needs to be flexibility because there may be circumstances where there actually needs to be an increase in payments for care. For example, a pandemic—an influenza pandemic where you might reasonably expect more people would need care; new developments in technology, which can help to save lives, improve the lives of those who have illnesses as well as prevent illnesses, might be a reason to have an increase in the cost of providing care. We believe that the authority of the IPAB needs to reflect that.
Zigmond: Mike, do you think that a private-public partnership in developing health insurance exchanges would be the best solution?
Michael Tuffin: We think there will be presumably 50 state solutions to this that will be slightly different state by state. And obviously, the spirit of an exchange is a public-private partnership, so I think broadly the answer is yes. More important is the architecture of these exchanges—that an exchange really be a place to create transparency and bring together buyers and sellers, and should afford flexibility and promote innovation and ensure that consumers, in addition to getting these consumer protections that they need and the security that an exchange will presumably provide, they're also getting a robust choice in a very competitive environment.
Zigmond: How do antitrust and fraud rules post barriers to physician participation in ACOs?
Wilson: Our concern is that if the ACOs end up being solely, for example, physician-hospital organizations, where hospitals are the driving force, that will actually decrease competition and not improve the system and will be a challenge. We believe it's important, as the law specifies, that these ACOs include not only physician-hospital organizations but others where physicians are in the lead. And we hope that the Federal Trade Commission in particular will make some changes in rulings, which will allow physicians to do what's called “clinically integrate” to negotiate prices and come together around quality, continuity of care and information technology.
Pollack: There's no question that we need to get those barriers eliminated that prevent the effective formation of these kinds of organizations. And the law actually gives the secretary of HHS some authority to do that with regard to the areas that are in these demonstration projects. But I'd just like to make another point around these ACOs, and this is that we think there ought to be flexibility, frankly, in how they are formulated or structured. In other words, there may be somewhere it is a physician group that is in a leadership role, and that's fine. There may be somewhere there are insurers in a leadership role, and that may be fine. There may be somewhere there are hospitals in a leadership role, and that may be fine. Our view is that there also ought to be plenty of room for partnerships.
Tuffin: We support the ACO concept, and we certainly want to encourage alternative payment models that will reward quality and help better coordinate care for patients. At the same time, we don't think you need kind of wholesale across-the-board exemptions from fraud and abuse laws to make this program successful. And we do have to be mindful of the risk of market concentration and market power.
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