Trump healthcare agenda: How hospitals can prepare

Although no one has a complete picture of what the healthcare industry will look like under the Trump administration in 2017, it’s clear that hospitals and healthcare systems must prepare for changes ahead for the Affordable Care Act, price transparency, Medicaid expansion and perhaps their continued participation in Medicare accountable care organizations.

The country, still reeling from Republican Donald Trump’s surprise election victory on Tuesday, now must look back at what he said during the campaign trail to figure out what his presidency will mean for healthcare,

Michael P. Strazzella

“Clearly the results stunned a lot of people,” Michael P. Strazzella, practice group leader, Federal Government Relations for Buchanan, Ingersoll & Rooney’s District of Columbia office, told FierceHealthcare during an exclusive interview on Thursday.

But, he says, advisers for Trump weren't taken by surprise. They have been working behind the scenes in preparation for his win and a transition plan. Among those advisers on healthcare is surgeon Ben Carson, who competed against Trump during the Republican primary campaign.

The repeal of Affordable Care Act

Trump's focus on the first day of his presidency will be the Affordable Care Act, says Strazzella. But despite the comments he made throughout his campaign, that doesn’t mean necessarily mean Trump will completely dismantle of the healthcare reform law on January 21

“Repeal is good campaign language but it’s a 2,000-plus page bill and not everything can be repealed,” he says.

Republicans and Trump don’t want to see millions of people to suddenly become uninsured, Strazzella says. The question the administration must grapple with is how to transition them so they can stay insured but also access more affordable health plans.

“There will not be a repeal of this without an alternative in place. There needs to be a transition to ensure there is no disruption in the market for those covered and the overall market. The healthcare delivery system was all encompassing in this bill,“ he says.

But what Trump can do in his first days of office without Congressional approval is withdraw the appeals of certain pieces of the law that are caught up in lawsuits. He can take action immediately on the appeal to cost-sharing subsidies, insist that the Department of Health and Human Services direct reinsurance payments back to the Treasury Department, and refuse to pay out risk corridor payments.

Hospital action steps

But where does this leave hospitals and healthcare systems that have agreed to cost-sharing proposals under the Medicare program if the ACA is rolled back? There certainly will be concerns about the additional costs involved in policies and programs put in place to replace the ACA, he says.

“I believe people need to take a hard look at their business models, where they fit in to Republican proposals driven by Trump,” Strazzella says.

And those provisions need to include some financial relief from the federal government for hospitals--already working on slim operating margins—that will need to spend more money to comply to new policies. Advocacy groups will push to make sure recovery audits appeals are done on a timely basis and that hospitals receive accurate payments under Meaningful Use, he predicts.

Trump is a business man at heart, who believes in a free market, where businesses can practice in a less government-mandated environment, Strazzella notes.  He also advocates complete price transparency of all healthcare providers so that consumers can shop for the best prices for procedures and exams.

Future of Shared Savings ACO programs

Less clear is what will become of some of the pilot programs, such as the accountable care organizations under the Medicare Shared Savings Programs that were endorsed by the Obama administration. Strazzella expects the Trump administration to take a close look at those programs to determine whether they are saving money as promised.

“President Trump will not be shy to hold back on those if he is not seeing the dollar savings and see if he can do it better in a different form,” he says.

Medicaid expansion may stall

And for states that have yet to expand Medicaid, Strazzella says they may want to wait to see what happens over the next few months. Trump, he says, has talked about moving people off Medicaid and to other forms of private insurance once we have a more predictable economy and the creation of more jobs.

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