Healthcare leaders spent the past six years figuring out how to operate under the Affordable Care Act. Now they're getting ready for a new blitz of policymaking that will come with the promised repeal under the Trump administration.
Acting CMS Administrator Andy Slavitt is urging lawmakers to improve on the progress made under the law rather than plunge the healthcare industry into chaos.
“There should be no pride of authorship,” Slavitt said last week at Modern Healthcare's 2016 Leadership Symposium in Chicago. “If we can improve upon the things that were started in the ACA, we should do it. It doesn't matter if that comes from a Democrat; it doesn't matter if it comes from a Republican. I would encourage people on both sides of the aisle to say, 'Let's take a step forward; let's focus on the things that haven't been working.' ”
Insurers are unsure how to set premium rates for 2018, which are due in the spring. Hospitals are concerned the progress they made toward value-based care will be stripped away. And consumers have made thousands of calls to the HealthCare.gov call center asking what will happen to their coverage.
“We're dealing with a third of the economy,” Slavitt said of the healthcare industry. “If you want to do a do-over, which is the other alternative to building on our progress, you're going to take a third of the economy and thrust it into some deep uncertainty.”
That wariness about undoing the work carrying out the ACA's many provisions over the past six years was echoed by CEOs of several large healthcare trade organizations who followed Slavitt in a panel discussion at the event.
“The key question will be whether the Republicans can be flexible enough to recognize, that whatever their concerns were about the funding allocations of national resources for healthcare through the Affordable Care Act, that it's not something we can just undo and go back to the start,” said Chip Kahn, CEO of the Federation of American Hospitals, the trade group representing for-profit hospitals.
Some healthcare leaders are particularly worried the Trump administration will slow the movement toward value-based payment models under Medicare's new physician payment system.
“We've made huge investments in infrastructure,” said Donald Fisher, CEO of the American Medical Group Association, which represents more than 400 health systems and 170,000 physicians. “We're ready to go.”
Under the Medicare Access and CHIP Reauthorization Act, or MACRA, physicians must participate in one of two reimbursement tracks. The program is meant to prod physicians away from fee-for-service payments, which reward providers for delivering more services regardless of the quality and efficiency of the care.
Stephen Ubl, CEO of Pharmaceutical Research and Manufacturers of America, countered that value-based payment is here to stay. “Our members are increasingly interested in being reimbursed differentially based on the outcome received by the patient,” he said. But he also said regulatory barriers are hindering the adoption of such arrangements. For example, Ubl said, drug companies can't communicate with insurers or hospitals before a drug hits the market.
Slavitt told the symposium, which was sponsored by Accumen, that lawmakers should be careful not to undermine the real progress the industry is making in the transition to value-based payment and delivery models, even if that progress is slow. We're on “the iPhone 2” version of accountable care organizations and medical homes, he said. “They are going to get a lot better … provided CMS does its job right.”