An Update from Leadership Health Care’s Delegation to D.C.By J.D. Thomas, Cory Brown | 03-13-2015
Earlier this week, we attended the Leadership Health Care delegation to Washington, D.C., where we were joined by 100 of our fellow Nashville healthcare industry friends to learn more about the policy and politics shaping our industry this year. During our two day visit, we heard from speakers ranging from Senators Alexander and Corker of Tennessee to Dr. Meena Seshamani from Health and Human Services' (HHS) Office for Health Reform to Anne Filipic of Enroll America. The speakers covered a diverse range of topics effecting the national and Tennessee healthcare industry. Here’s what we heard:
- King v. Burwell: Discussion of what would occur should the Supreme Court invalidate subsidies in states that didn’t set up an exchange, such as Tennessee, was a constant theme of the meeting. Right now, Washington is patiently awaiting the Court’s ruling, expected sometime in June, which could eliminate health insurance subsidies for about 8 million Americans. Former U.S. Senate Majority Leader Tom Daschle said that while Congress can find bipartisan support on some fronts, the Affordable Care Act is one that remains divided. [Additional coverage on King v. Burwell can be found here.]
- Medicaid expansion: Several speakers discussed the political and practical aspects as well as the economic benefits of Medicaid expansion. In those states that have expanded Medicaid, there has been a marked decline in the number of uninsured admissions and uncompensated care. Much like what Tennessee tried to do, commentators in D.C. said that we may see more attempts at expansion in Republican states if their governors can find a way to do it and the federal government is willing to work with them on waivers.
- Value-based payments: The rise of value-based payment systems and the push from CMS to enact delivery reform and tie more reimbursement to value-based models was a hot topic of discussion, with many of those in attendance asking questions and contributing to the discussion. Dr. Meena Seshamani, Director of HHS’s Office of Health Reform mentioned their motto of "better smarter healthier,” which entails a few key steps: 1) Value-based payment; 2) care coordination; and 3) information use (electronic health records (EHRs), evidence-based care, etc.). Thirty percent of payments by 2016 and fifty percent by 2018 will be linked to value-based payment systems and a certain percentage of fee-for-service will be linked to quality measures. Many other speakers emphasized the fact that with value-based medicine, information and data analytics, both the sharing of information as well as the analysis of it, is even more important. Providers perhaps need to revisit their ability to share and access health information and continue to wrestle with EHR interoperability.
- Fraud and abuse laws: The speakers acknowledged that the fraud and abuse laws, as currently drafted and enforced, create unintended impediments to effective cooperation among providers in delivering quality care. Healthcare providers are spending increasing amounts of resources, particularly in legal costs, to comply with the ever growing regulatory restrictions and requirements governing reimbursement. Certain members of Congress are actively seeking to reform fraud and abuse laws to allow providers to engage in various initiatives and explore responsible delivery options without the overarching fear of prosecution by regulatory authorities. Nonetheless, there was clear agreement that the ongoing push to investigate and prosecute fraud and abuse throughout the healthcare system is here to stay.
- Interoperability: Dr. Karen B. DeSalvo, HHS’s Acting Assistant Secretary for Health and the National Coordinator for HIT, provided fascinating commentary on the administration’s ongoing health IT efforts. The clear takeaway from her comments was that she plans to address and wants to solve issues of interoperability among EHR systems.
- Legislative issues: Finally, a panel of key house and senate staffers provided insights into many of what they termed “must address” legislative issues affecting the healthcare industry that they expect Congress to take up this year. While several admitted that the prospects of compromise in Congress are diminishing, they do expect a further SGR payment patch and an extension of CHIP benefits. They were also hopeful that if the Supreme Court ruled against the ACA in King v. Burwell that Congress would find a way to at least limit the immediate impact to consumers in federal exchange states.
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