Lead­ers prep for a post-ACA re­al­ity

Modern Healthcare - - NEWS - By Shelby Liv­ingston

“There should be no pride of au­thor­ship. If we can im­prove upon the things that were started in the ACA, we should do it.” ANDY SLAVITT Act­ing CMS ad­min­is­tra­tor

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 un­rav­el­ing the work car­ry­ing out the ACA’s many pro­vi­sions 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 not un­der­mine the real progress the in­dus­try is mak­ing in the tran­si­tion to val­ue­based 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.”


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