Monday, November 10, 2014

What Do the Recent Election Mean For Healthcare

By: Bill Cockrell with Cockrell and Associates, LLC

The fact that the Senate will now be under Republican leadership means there are a lot of thoughts about what will happen with the Affordable Care Act (ACA or “Obamacare”). This includes questions ranging from Medicaid enrollment to incentives (federal and by payer) to the elimination of the entire program all together. While there a good and bad parts of the program, there are many parts to the bigger picture. Here are some thoughts on that.

Overall – While the ACA is viewed to be a major thorn in the sides of providers, and many individuals, here are just a few elements to consider.

The House and Senate are both now in the hands of Republicans but that does not give them the freedom to do what they want. The President still has veto power and the Republicans did not receive enough seats, unless some Democrats cross over, to eliminate the program altogether.

Many people, millions, did receive healthcare coverage they did not have before. Rather they were without insurance because of individual cost, the lack of employer support or other reasons, they did see benefits which will be hard to take away.

The role of mandates, subsidies and taxes on certain healthcare items are those where the most change will occur.

Medicaid expansion, in most states, has too much steam to change, again, because of coverage being expanded to more individuals. What Alabama will do remains to be seen but don’t be surprised to see some expansion here at some point.

Bottom line, expect some fine tuning, some of it significant, but don’t expect the ACA to go away.

Meaningful Use and EHR Incentives – These were not part of the ACA. They had their beginnings before the ACA and were not part of it. Again, some fine tuning will occur along with additional delays (this will not require congressional legislation), but this will remain part of our healthcare environment.

Payers – With little of these individual program’s (Medicare Advantage plans, etc.) elements driven by government regulations, the process of restricted networks and individual incentive plans, will continue. From the Alabama BCBS Value Based Program and other incentive plans introduced by other providers, to Medicare’s, and other provider’s annual risk assessments as part of their Medicare Advantage plans. Expect further expansion. These are in place to control costs and will continue.

Medical Homes, ACO’s, and other special programs – Again, not driven by the ACA, these programs will continue to expand. There is evidence to support their value although the market itself (financial issues) may restrict the growth of ACO’s. Indeed, an SGR fix (see below) may hasten them.

Alabama Medicaid and Regional Care Organizations (RCO’s) in Alabama are coming and, with success seen in Oregon, one of the models the Alabama ACO’s are based on, they will occur. What potential Medicaid expansion and the difficulties in managing the many elements involved, this will be something providers.

The SGR fix – The Sustainable Growth Rate program for Medicare predates many of the above programs and will not be impacted by any changes in their programs. Last year proposed fix, driven by a combined Republican / Democrat (rare as it is) agreement, pushed more to reducing annual fee adjustments to increasing the role of Alternative Payment Models. This pushes more on the Pay for Performance program models (Medical Homes, shared savings, episode of care reimbursement, etc.) and we can expect more of this. A bright side will be combining many of the existing programs (PQRS, ePrescibe, etc.) into a consolidated model. This fix will occur, again with some possible modifications, with the question being whether or not a lame duck Congress finish what they started, or will it be delayed again until after the new Congress steps in.

ICD-10 – Expect this to finally occur in 2015. There have been many delays but a lot of money has been spent by system vendors and providers to prepare for this. The detail provided by enhanced coding plays well in many of the above programs.

No comments:

Post a Comment