The results of Tuesday’s election were improbable, according to most forecasters and pundits. Aetna CEO Mark Bertolini claimed Wednesday that his team didn’t forecast the impact of a Donald Trump victory because it seemed so unlikely. Perhaps more consequential to healthcare than the Presidency alone is that the Republican party now also controls the house of representatives and the senate.
What does this mean for the multi-trillion dollar US healthcare industry? Beyond promising unspecified change to the current Affordable Care Act, healthcare was hardly discussed on the campaign trail and both candidates offered little specifics on their plans.. President-elect Trump announced that healthcare will be the first priority of his administration and reportedly named Andrew Bremberg to lead the healthcare transition team, along with Paula Stennard to help develop healthcare policy. Both Bremberg and Stennard are relatively established policy consultants who have worked for Republican politicians in the past.
Despite the mantra, “Repeal and Replace [the Affordable Care Act]” on the campaign trail, the President-elect has expressed desire for some parts of the law to remain intact: specifically, the ban on discriminating against patients with pre-existing conditions and allowing children to remain on their parents’ policies until age 26. Realistically, it will be up to both parties in Congress to discuss and compromise on specific tenets of any reform policy, as Republicans lack a ‘Supermajority’ to bypass Democrats on the floor.
HHS and the implications for Healthcare IT
Industry publication Health Data Management suggests that specific value-based care initiatives may be in jeopardy, though not necessarily the concepts. Republicans in Congress questioned the speed at which current HHS secretary Sylvia Burwell wanted to transition healthcare providers to value-based care from the original fee-for-service model. Healthcare stakeholders can agree on testing and implicating promising new models, at least in theory.
On the physician side, Forbes expects MACRA not to be repealed, citing that the law was a bi-partisan effort developed by a Republican-controlled Congress and signed by President Obama. MACRA goes into effect just before President-elect Trump takes office, so stakeholders have yet to judge its practical effects.
Certain areas of healthcare IT will subject to bipartisan changes. Given the number of cyberattacks in healthcare in 2016 so far, we can anticipate adaptations to current regulations. We can also expect the ‘shift to consumerism’ to continue, especially for price transparency, which was specifically mentioned in Trump’s campaign platform. Approximately 95% of hospitals and 80% of physician practices already use accredited electronic health records technology, so it’s reasonable to assume that the remainder of providers will transition eventually, with or without legislation.
Healthcare Revenue Cycle and Patient Payments
In 2017, it’s likely that the ACA will remain largely intact, due to the time it will take to develop and debate alternative policy. We noted last week that increasing premiums and deductibles will put a slightly greater financial strain on patients. While repealing the ACA entirely could remove coverage from up to 25 million patients, the President-elect could expand Medicaid and lower uncompensated care costs, especially in states that chose not to accept the Medicaid expansion.
If insurance companies are allowed to sell insurance across state lines, as Trump expressed desire for during his campaign, we might see broader consolidated risk pools and more stable, though not necessarily cheaper, rates. Larger insurance pools could give insurance companies more leverage to create broader networks of care, as long as the terms allow healthcare providers to financially sustain themselves. Considered a highly partisan issue, many on the left are skeptical of this strategy.
One important sector to watch is urgent care clinics and ‘retail’ medicine. If the delivered reforms don’t sufficiently cover the majority of Americans, we can expect to see the proliferation of these clinics which are independent of Medicare reimbursement and therefore free to charge what the market allows. Telemedicine follows suit, with widespread usage limited only by the current regulatory environment.
Addressing Increased Patient Financial Responsibility in 2017
In the coming year, providers should continue to address the given challenges associated with increased patient financial responsibility until a new policy is announced. Price transparency, patient financing options, and convenient payment methods will help drive volume and patient satisfaction. Augment your staff’s productivity by automating manual functions like reconciliation and posting. No matter which policy comes from the incoming administration, providers will always need to process patient payments and provide a positive holistic patient experience.