By Tony Schueth, CEO
The voters have spoken and there will be a new administration in roughly two months. What does this mean for health information technology (health IT)? Point-of-Care Partners (POCP) convened its senior consultants and took a look at the tea leaves. Here’s our preliminary take on at the short-term impacts.
At the federal level:
Affordable Care Act (ACA). President-elect Donald Trump was vocal about wanting to repeal and replace parts of this law during his campaign. We believe he will make good on this promise. Early reports indicate this could happen quickly. Making modifications to ACA is likely to occupy a lot of time and energy by the Congress and his administration this coming spring. Replacement legislation could have cascading effects on health IT, such as requiring changes to the health care infrastructure emphasizing interoperability, connectivity and information exchange. Moving millions of patients off and on various public and private insurance plans also creates demand for health IT and a new patient identifier (for a primer on this issue, see our article in the November issue of HIT Perspectives). It also is possible that the Center for Medicare and Medicaid Innovation will be in the crosshairs. If it survives, it may no longer be an agent of change.
Medicare and CHIP Reauthorization Act (MACRA). The new administration will continue implementation of the health IT provisions contained in the Merit-Based Incentive Payment System (MIPS), which is one of two Medicare payment tracks authorized under MACRA (for more detail, see our blog). The health IT part of MIPS accounts for a quarter of physicians’ scores for Medicare payments under this track. Details were spelled out in a recent final rule, which we do not expect will be revisited in the near future. However, President-elect Trump has promised to reduce government regulations, and this new rule is long and complicated. It is possible that once stakeholders have had a chance to digest this regulation and size up the new administration, there could be movement for something different down the line.
21st Century Cures Act. We should not overlook this bipartisan legislation, which has been a work in progress for more than a year (not to mention 19 separate amendments in the Senate). Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan recently announced that final touches were being made to the legislation and they expect to have it on President Barack Obama’s desk by the end of the year. He presumably will sign it because it’s a bipartisan effort and seemingly has “motherhood and apple pie” provisions (although advocates have concerns about some of them). If signed, the Trump administration will have to implement it.
Most people are familiar with this proposed law because it would provide additional funding to the National Institutes of Health and streamline requirements for drug approval by the Food and Drug Administration. Of interest to health IT junkies is Section 3001, Interoperability. According to a summary, these provisions would “refocus national efforts on making systems interoperable and holding individuals responsible for blocking or otherwise inhibiting the flow of patient information throughout our health care system.” How these provisions would mesh with efforts under way by the Office of the National Coordinator for Health IT (ONC) concerning information blocking have yet to be determined.
The first is secretary of the Department of Health and Human Services (HHS), for which Dr. Ben Carson is rumored to be under consideration. We don’t know Dr. Carson’s experience or level of interest in health IT. However, because of HHS’ regulation of health IT and its use in research, quality and payment, the secretary will be involved. The incoming secretary will also need to rely heavily on the new administrator of the Centers for Medicare and Medicaid Services (CMS) and the head of the ONC. This is where the rubber hits the road when it comes to health IT. The CMS will continue its work on standards for Medicare Part D and implementing MIPS’ health IT provisions. We expect the ONC to continue its certification of health IT as required under MIPS. It also is likely to remain the focal point of interoperability, including addressing information blocking, as expressed in a recent report to Congress. That said, it is unclear whether this issue will be of interest to the Trump administration.
We also should not overlook the head of the Centers for Disease Control and Prevention (CDC). Don’t forget that the CDC has been involved in health IT, including monitoring progress toward adoption of electronic health records and issuing a 10-year interoperability plan. Will the agency continue to have a say in health IT in the Trump administration or will it return to its traditional focus on health promotion and disease prevention?
Two transition advisors could have some very influential thoughts as to who might fill these HHS jobs and what their portfolios might be. The first is Newt Gingrich. While he is expected to fill an as yet unspecified role in the administration, Gingrich nonetheless knows quite a bit about health IT. He was heavily involved in health IT circa 2005; his organization, the Center for Health Transformation, authored the book Paper Kills, which was among the first publications to promote the need for and benefits of health IT. The second is Mike Leavitt, former governor of Utah who then served as HHS secretary from 2005 to 2009. In the latter capacity, he oversaw a considerable number of groundbreaking efforts and policies related to health IT, including those related to electronic prescribing under Medicare Part D.
Another potential appointment of interest, although in the longer term, is head of the Veterans Administration (VA). If the VA privatizes some facets of veterans’ care, there will be new and considerable demand for health IT infrastructure and connectivity — as well as the need for a national patient identifier and work on more accurately enabling health IT to connect patients to their records across the health care system.
At the industry level, we see several things happening in relation to health IT. For example:
All in all, we believe health IT to be an integral part of the solution, not part of the problem (although we admit there are, well, opportunities for improvement). The keys will be actors, agents and timing. POCP is closely monitoring the transition. Stay tuned for future blogs as developments unfold.