With Donald Trump's presidential inauguration set for January 20, questions abound as to how his administration -- and Republican majorities in both the U.S. House of Representatives and the Senate -- will set about changing healthcare in the U.S.
There are four crucial areas of healthcare that could be affected, according to an opinion article published online January 9 in the Journal of the American College of Radiology. Smart radiologists should definitely track any looming changes.
"Radiologists are encouraged to maintain an awareness of the likely developments, as their practice and payment models stand to be influenced by changes in federal legislation," wrote the team led by Dr. Andrew Rosenkrantz of NYU Langone Medical Center (JACR, January 9, 2017).
Drawing out the details
Rosenkrantz and colleagues Dr. Gregory Nicola of Hackensack Radiology Group in River Edge, NJ, and Dr. Joshua Hirsch of Massachusetts General Hospital outlined how four types of healthcare legislation could be affected by the new administration.
1. ACA
The Affordable Care Act (ACA) was passed in 2010 and ever since has been under attack by the Republican Party, the authors wrote. Republicans have vowed to repeal it, or at least dismantle it; on January 12 and 13, the Senate and House approved a concurrent resolution using the annual budget reconciliation process to set that goal into motion. The resolution calls for congressional committees to submit repeal legislation by January 27.
2. Authority over physician practice and payment
A trend toward shifting authority over physician practice and payment from the legislative branch to the executive branch began under the Obama administration, according to Rosenkrantz and colleagues. One example is the Center for Medicare and Medicaid Innovation (CMMI), which implements and evaluates payments and healthcare delivery system models, trying to improve the quality of care and control costs at the same time. Congressional Republicans will likely lobby to reduce the power of the CMMI, as well as seek to repeal the Independent Payment Advisory Board (IPAB), an agency established by the ACA with authority to reduce federal healthcare spending through recommendations to Congress.
The incoming administration has also supported a plan to convert Medicaid to a "block grant" program, under which states receive fixed amounts of funding regardless of total enrollment -- making them responsible for paying for a larger share of benefits. And it has supported converting Medicare to a premium or voucher-based privatized system, under which the government would pay a fixed amount per enrollee, rather than covering all billed services on a fee-for-service basis, the group wrote.
3. MACRA
The Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015. It stabilized the Medicare Physician Fee Schedule (MPFS) by repealing the sustainable growth rate (SGR), and it implemented a quality payment program to base Medicare payments on the quality and cost of care, the authors wrote. Although MACRA will probably remain generally intact, its long-term effectiveness may be weakened if the CMMI is eliminated, as testing of alternative payment models has been conducted by that group.
The problem is that practices have been gearing up to comply with MACRA mandates, many of which went into effect this month, Rosenkrantz told AuntMinnie.com. But will a new secretary of the U.S. Department of Health and Human Services -- Trump's pick is Dr. Tom Price, an orthopedic surgeon and Republican representative from Georgia -- throw a wrench in the works?
"Practices have invested a lot of resources getting ready for MACRA, but under Price's leadership, how MACRA is implemented could change dramatically," he said.
4. Tort reform
Tort reform for medical malpractice may be affected by the new administration, as the Republican Party has a long record of supporting such reform, particularly bills that set caps on compensation for noneconomic damages, according to Rosenkrantz and colleagues.
"Although previously deemed to be a matter of state authority, malpractice reform could re-emerge as a national issue in light of the new Republican mandate," they wrote.
Be vigilant
So what should radiologists do in this time of flux? Be vigilant, Rosenkrantz told AuntMinnie.com.
"Federal healthcare policy can influence our day-to-day practice, and with this new administration, there's a strong possibility that big changes are coming," he said. "We have to continue to take action to succeed under current payment and policy models, but also be aware that things could shift quickly."
