The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717 Pennsylvania Avenue, not Santa at the North Pole) advised the incoming President of its own public policy priorities and their vision for healthcare reform. Some of their requests seem to come out of Trump’s playbook – such as removing burdensome regulations on hospitals. But some may not find the same sympathetic audience – such as imposing regulations on those industries that drive up hospital costs and those that hold down hospital reimbursements. The following summarizes the AHA’s recommendations for improving the healthcare landscape:
A) Reducing regulatory burdens. Consistent with President-Elect Trump’s frequent refrain of the need to eliminate most federal regulations that prevent US businesses from growing, the AHA has identified several opportunities for doing exactly that:
- Cancel stage 3 of the meaningful use program that would require costly upgrades of EHR;
- Revise the RAC contracts to impose on the contractors penalties for high rates of incorrect denials leading to unnecessary appeals that contribute to a backlog of claims awaiting adjudication;
- Create further exceptions and safe harbors under the Anti-Kickback Statute (“AKS”) to protect clinical integration arrangements while revising the Stark Law to protect arrangements that satisfy those AKS safe harbors;
- Standardize the federal merger review process between the FTC and DOJ;
- Eliminate post-acute care regulations that threaten access, such as the LTCH 25% Rule and the home health agency pre-claim review demonstration project.
B) Enhancing health care affordability and value. The AHA explained that increased spending on hospital care is primarily attributable to pressures on hospital reimbursement and increasing hospital expenses that are outside hospitals’ control and that should be controlled in other manners. Specifically:
- Adopting solutions to escalating drug prices;
- Protecting the 340B Drug Pricing Program;
- Challenging major health insurance company mergers;
- Instituting malpractice reform; and
- Overhauling Medicare through structural changes such as combining Parts A and B, limiting Medigap coverage, implementing further means-testing for Medicare premiums and raising the eligibility age.
C) Promoting quality and patient safety. While the AHA highlights the need to promote quality and patient safety, in this section the letter actually highlights:
- Several ways to rework the quality reporting requirements that are overlapping, conflicting and fail to focus on actual opportunities to improve care;
- The need to modify the current readmissions policy to avoid penalizing providers for factors outside their control;
- The need to support the adoption of interoperable EHRs with consistent IT standards; and
- Rejecting reductions in Medicare funding for GME.
D) Ensuring access to care and coverage. While recognizing that the ACA needed reform, the letter reminds the Trump administration of the 20 million uninsured individuals that found insurance through the ACA and urges the new administration to continue funding CHIP, improve access to mental health services through various means, encourage and make permanent the Veterans Choice Program and reject “site-neutral” payment cuts that prevent hospitals from modernizing its facilities.
E) Advancing health system transformation and innovation. The AHA seeks support for hospitals to preserve and improve upon new payment and delivery models; promote telehealth and similar technologies; and implement changes to ACO models and alternative payment models and otherwise “provide new options on care delivery that reward better, more efficient, coordinated care and help ensure access to essential health care services.”
Finally, the AHA urges the administration not to implement any abrupt changes that would cause instability in the health care marketplace. Specifically, the AHA calls on the administration to couple any repeal of portions of the ACA with the simultaneous implementation of a replacement plan to provide affordable coverage for individuals.
While the AHA’s call for removal of burdensome provider regulations would seem to appeal to the President-Elect, the AHA’s call for the imposition of new regulations on other industries that impact hospital costs and reimbursements, and its requests for further funding may not be met with the same understanding. While we think it is unlikely that the AHA will get coal in its stocking next year, we also don’t expect that Red Ryder Carbine Action 200-shot Range Model B.B. gun waiting under the tree (you could put your eye out with that).