Beyond any potential impact to the Affordable Care Act, policy priorities from the incoming presidential administration and a Republican-led Congress could impact healthcare organizations in ways both positive and negative, according to a report from the Healthcare Financial Management Association.
Based on previously published whitepapers and legislative concept documents, HFMA identified a number of different policy proposals and ranked them in terms of probability and positive or negative financial impact.
The policy with the highest probability of enactment and worst financial impact will be the continuation of Medicare payment cuts, said HFMA. Any repeal-and-replace legislation passed through budget reconciliation would need to be budget neutral at a minimum; future anticipated tax reforms or infrastructure spending will likely exacerbate federal budget challenges, the agency said, spurring further Medicare payment reductions.
[Also: Fate of ACA-shrouded CMMI uncertain, but could prove useful to GOP leaders in revamping Medicare]
HFMA views another likely policy as more beneficial: the continued transition to outcomes-based payment. Both parties generally support the shift to this kind of payment model, with MACRA, a bipartisan piece of legislation, serving as Exhibit A. MACRA implements physician value-based payment and encourages the transition to risk-bearing alternative payment models.
Beyond MACRA, however, there may be some differences in how the new administration implements some of these changes. The Obama administration favored a federal approach led by the Center for Medicare and Medicaid Innovation, but team Trump may allow states more flexibility, via waivers, to implement state-specific financing and payment reforms.
A likely policy identified by HFMA as financially advantageous is repeal of the Independent Payment Advisory Board. Simply put, the board is disliked by both parties and both chambers of Congress. If spending growth thresholds are triggered, it implements mandatory payment cuts; eliminating it would require just $7 billion in offsetting spending cuts, so action is likely.
Curtailing mandatory CMMI innovation models is also fairly likely, and could have a positive impact. House Republicans believe CMMI overstepped its authority by mandating participation in programs like the proposed Part B Payment Model, proposed cardiac/fracture episodes, and the Comprehensive Care for Joint Replacement model. Repeal has been proposed, but it's likely CMMI will continue, but with some legislative or administrative prohibitions on mandating programs. The cost of repealing CMMI, at $34 billion, is prohibitive, and its work is important for the development of alternative payment models. Existing programs would likely continue as they are. New programs, at a minimum, would likely include opportunities for physician practices to the "APM Entity," of not be focused on them, due to MACRA.
Of course, repealing and replacing the ACA has long been a conservative war cry, and while it's somewhat likely, HFMA views this probable action negatively. Repeal proposals would eliminate Medicaid funding for the expansion population. Decreases in coverage would likely vary from market to market. States would have the option to continue Medicaid funding on their own, and some may, albeit with stricter eligibility requirements. Generally, HFMA anticipates that the markets that saw the greatest gains on coverage -- urban markets in expansion states, mostly -- will see the greatest losses.
Proposed policies views as less likely by HFMA include converting Medicaid to a block grant, and making changes to the Medicare/Medicaid Disproportionate Share Hospitals.
Twitter: @JELagasse