In a November 30 letter to President-elect Donald Trump, American Hospital Association (AHA) president and CEO Richard J. Pollack has outlined actions the new administration could take that would allow health care organizations and providers to improve care and make it more affordable to patients. At the top of the list are steps to reduce the regulatory burden on hospitals and providers.
“To help advance health in America, we ask that your administration––in collaboration with Congress and the courts, and in partnership with health care providers––help modernize the public policy environment to enhance providers’ ability to improve care and make it more affordable for patients,” Pollack wrote.
Specifically, he urged Trump to:
- Cancel Stage 3 of the meaningful use program so that hospitals will not be forced to spend large sums of money upgrading their electronic health records solely for the purpose of meeting regulatory requirements.
- Revise the recovery auditor contractor (RAC) contracts to incorporate a financial penalty for high rates of incorrect denials that lead to unnecessary appeals, which is contributing to a multiyear backlog of claims awaiting adjudication.
- Create exception safe harbors and waivers under the antikickback statute to protect clinical integration arrangements and revise the “Stark law” to protect arrangements that meet the antikickback safe harbor so that physicians and hospitals can work together to improve care.
- Standardize the federal merger review process between the Federal Trade Commission and the Department of Justice to better support hospital transformation.
- Eliminate outdated regulations that threaten access to post-acute care, such as the long-term care hospital “25% rule” and the home health agency pre-claim review demonstration project.
Pollack’s letter also suggested ways the new administration could enhance affordability and value, including:
- Adopt a comprehensive set of solutions to address escalating drug prices, including providing support for the introduction of generic alternatives; discouraging anticompetitive tactics, such as “pay-for-delay” and “evergreening;” improving access through drug reimportation; providing mandatory rebates; and placing requirements on direct-to-consumer advertising.
- Protect the 340B drug-pricing program, which allows eligible hospitals to reduce the price of expensive outpatient pharmaceuticals for patients.
- Continue to challenge the major health insurance company mergers and other anticompetitive conduct to prevent harmful repercussions for consumers and providers.
- Explore policies to help rein in medical liability, such as instituting a cap on noneconomic damages and allowing courts to limit lawyers’ contingency fees.
- Explore Medicare structural reforms to make the program more sustainable while maintaining access to care, ensuring adequate payment for care, and protecting individuals from excessive financial burden, such as combining Medicare Parts A and B, limiting Medigap coverage, further means-testing Medicare premiums, and raising the Medicare eligibility age.
“Improvements in quality and patient safety are accelerating, but providers are stymied by an ever-increasing number of quality-reporting requirements, many of which are overlapping, conflicting, and fail to focus on actual opportunities to improve care,” Pollack wrote. He offered Trump several potential solutions:
- Streamline, prioritize, and simplify quality reporting to identify and focus on “meaningful and valid measures that matter.”
- Modify the current readmissions policy to include a sociodemographic adjustment so that providers are not penalized for factors outside of their control.
- Suspend the flawed hospital star ratings on the Hospital Compare website, as they are “inaccurate and provide misleading information to consumers.”
- Develop a performance reporting option that allows hospital-aligned physicians to fulfill the Medicare Access and CHIP Reauthorization Act (MACRA) quality reporting requirements based on hospital measures.
- Stop federal agency intrusion into private-sector accrediting body standards and survey processes.
- Advance health information technology (IT) by supporting the adoption of interoperable EHRs, by promoting the consistent use of IT standards, and by providing improved testing, certification, and transparency about vendor products.
- Reject reductions in Medicare funding for graduate medical education to ensure that the United States has the workforce necessary to provide high-quality, safe care to patients.
Sources: AHA; November 30, 2016; and FierceHealthcare; December 1, 2016.