HIMSS 2017: Health IT leaders mixed on potential Affordable Care Act repeal and replace

ORLANDO, Fla.—Healthcare IT executives voiced a broad range of perspectives regarding potential changes to the Affordable Care Act and any replacement plans that might follow. Some worried that any changes to the law will put additional pressure on already tight budgets, while larger integrated systems insisted they were well-positioned to weather a revamped regulatory framework.

President Donald Trump has repeatedly vowed to repeal and replace the ACA, a promise he emphasized during an address to a joint session of Congress Tuesday evening, calling on “Democrats and Republicans in Congress to work with us to save Americans from this imploding Obamacare disaster.” However, intraparty discord has left the GOP unable to agree on a replacement plan. 

Executives spoke with FierceHealthcare at the annual HIMSS conference in Orlando, Florida, about prospective changes to the healthcare landscape and what an overhaul of the landmark healthcare law could mean for IT budgets and investment opportunities. Several noted that any changes could trickle down to IT budgets, forcing them to reprioritize ongoing or prospective IT initiatives.

Some, like Jacques Orces, D.O., chief medical information officer at Miami Children’s Health System, said an ACA repeal will hurt his system's bottom line following a seven-year period of financial improvement when more children in the Miami area had coverage.

“We have razor-narrow margins,” Orces said, adding that the vast majority of the patient population is on Medicaid. “Any changes in the reimbursement lines will definitely affect us. We’re already looking to see how we can maintain quality and lower cost.”

Orces noted that IT budgets are “always a big target in the room” when it comes time to make cuts. Kathi Cox, senior director of the system integration and innovation office at the not-for-profit Texas Health Resources echoed similar concerns, but she added that regulatory changes of any kind put additional pressure on hospital budgets. Cox said her system is still recovering from the regulatory burdens of ACA, but a repeal won’t necessarily offer any more wiggle room, especially since providers still don’t know what a replacement plan will look like.

“We already don’t have as many resources we need in order to develop real tools for all of our caregivers, or any kind of user, from the frontline on up,” she said. “Now you turn it a little tighter, and we’re going to have to deprioritize some things so that we can concentrate where we need to concentrate to do whatever it is we need to do.”

But other executives offered a markedly different perspective. C. Talbot Heppenstall, Jr., treasurer and executive vice president of the University of Pittsburgh Medical Center (UPMC) and president of UPMC Enterprise, said the integrated health system is well-positioned to absorb any changes to the ACA, in part because it has always focused on high quality and low-cost patient management.

“We actually look at all this disruption as an opportunity for us,” he said. “There is this theory of the haves and have-nots in healthcare and there are a lot of smaller providers running for cover and saying, ‘I need to be a part of something bigger.’ Luckily at UPMC, we are the something bigger. We think it’s actually an opportunity for us to continue to grow.

“I expect this current healthcare environment will wind up with UPMC getting bigger much faster than it would have,” he added.

UPMC Enterprises, the system’s innovation and commercialization arm that leverages expertise from the clinical side to invest in healthcare technology companies, won’t change its approach either, which bodes well for the health system’s access to new technology.

“The model we built is nimble enough to adjust to whatever decisions are made,” said Ed McCallister, senior vice president and CIO at UPMC.

Don Lindsey, vice president and CIO of the nonprofit Tallahassee Memorial Healthcare, said any changes at the federal level won’t have a huge impact on the system’s trajectory, although it could force the IT department to reprioritize certain issues depending on the resources available.

“The way I see it, changes happen all the time,” he said. “It doesn’t affect where we go, all it effects is the timing of what we implement.”

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Vendors find themselves in an entirely different position, searching for ways to fill any gaps that open up following an ACA repeal. S.V. Mahadevan, M.D., a professor of emergency medicine at Stanford University Medical Center, and chief medical advisor for Praxify, a mobile app designed to improve EHR efficiency, said health IT vendors have an opportunity to identify ways to improve productivity, which is likely become even more valued among providers.

“We’re never going back to pen and paper,” he said. “It creates opportunities for companies that are stealthy and can take advantage to provide efficiencies and advancement.”