The American Hospital Association (AHA) has urged President Donald Trump to avoid “abrupt changes” to the Affordable Care Act that could destabilize the health care sector.
The plea from AHA President and CEO Rick Pollack came near the end of a four-page wish list the hospital lobby sent to the President, who has vowed to repeal Obamacare.
Mr. Pollack’s letter highlighted five areas of concern for hospitals: reducing the regulatory burden; enhancing affordability and value; continuing to promote quality and patient safety; ensuring access to care and coverage; and continuing to advance health care system transformation and innovation.
“The regulatory burden faced by hospitals is substantial and unsustainable,” Mr. Pollack said. “Reducing the administrative complexity of health care would save billions of dollars annually and would allow providers to spend more time on patients, not paperwork.”
The AHA wants the Trump administration to:
Cancel Stage 3 of the meaningful use program.
Incorporate a financial penalty for high rates of incorrect denials that lead to unnecessary appeals in the auditor contractor contracts.
Create safe harbors and waivers under the antikickback statute.
Revise the Stark law on physician self-referral.
Standardize the federal merger review process between the Federal Trade Commission and the Department of Justice.
Eliminate outdated regulations that threaten access to postacute care.
Adopt comprehensive solutions to address escalating drug prices.
Protect the 340B drug pricing program.
Continue to challenge major health insurance company mergers and other anticompetitive conduct.
Explore policies to help rein in medical liability.
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.
To promote quality and patient safety, the Trump administration was asked to:
Streamline, prioritize, and simplify quality reporting.
Modify the current readmissions policy to include a sociodemographic adjustment.
Suspend the flawed and misleading hospital star ratings on the Hospital Compare website.
Develop a performance reporting option that allows hospital-aligned physicians to fulfill the Medicare Access and CHIP Reauthorization Act quality reporting requirements based on hospital measures.
Stop federal agency intrusion in private sector accrediting body standards and survey processes.
Advance health information technology by supporting the adoption of interoperable electronic health records and promote more consistent use of information technology standards.
Reject reductions in Medicare funding for graduate medical education.
Continue funding for the Children’s Health Insurance Program.
Improve access to mental health services.
Remove barriers to mental health treatment.
Provide funding to implement the Comprehensive Addiction and Recovery Act.
Reject “site-neutral” payment cuts that prevent hospitals from modernizing their facilities.
Urge Congress to remove impediments preventing veterans from using the Veterans Choice Program.
To advance health system transformation and innovation, the new administration was asked to:
Preserve and improve upon new payment and delivery models
Promote the use of telehealth and remote patient monitoring
Waive the skilled nursing facility three-day stay rule, telehealth restrictions, and prospective beneficiary assignment from all Accountable Care Organization models
Expand the definition of advanced alternative payment models
Provide new options on care delivery that reward better, more efficient, coordinated care and help ensure access to essential health care services
Dr. Goyal is associate executive director of quality for ACEP.
Emergency Medicine Health Care Reform Principles
As Congress takes up the future of the Patient Protection and Affordable Care Act, or Obamacare, ACEP issued an outline of emergency medicine health care reform principles it considers indispensable to any replacement legislation. The principles aim to maximize access to medical care while improving its quality and lowering its costs.
“Although the nation’s emergency departments continue to focus on our traditional mission of providing urgent and lifesaving care, our role has expanded over the last several decades to encompass safety net care for uninsured and underinsured patients, public health surveillance, disaster preparedness, and filling gaps in care caused by physician shortages,” said ACEP President Rebecca Parker, MD, FACEP.
“Reimbursement reductions from public and private payers have substantially curtailed hospital capacity, which is extremely concerning for any community which might be faced with a severe disease outbreak or mass casualty event,” she said.
ACEP believes all Americans must have health care coverage, and we urge lawmakers to consider the following principles as they develop new health care policies:
Maintain emergency services as a covered benefit for any insurance plan.
Ensure the federal Prudent Layperson Standard extends to Medicaid fee-for-service and that compliance measures are in place for all other health plans.
Require health insurance transparency of data used to determine in- and out-of-network reimbursement rates for their patients’ medical care. Ensure appropriate reimbursement rates for emergency services.
Eliminate need for prior authorization for emergency services and guarantee parity in coverage and patient co-payments for in- and out-of-network emergency care services.
Retain protections for pre-existing conditions, no lifetime limits, and allowing children to remain on their parents’ insurance plan until age 26.
Enact meaningful medical liability reforms, including protections for physicians who provide federally-mandated EMTALA-related services, care for patients in a federally declared disaster area, and who follow clinical guidelines established by national medical specialty societies.
Ensure any continuation or expansion of Health Savings Accounts, Health Reimbursement Accounts, Association Health Plans, and Individual Health Pools provide meaningful health insurance benefits and coverage for individuals and families, including access to emergency care services.
Repeal the Independent Payment Advisory Board and the excise tax on high-cost employer health benefit plans. Delay repeal of the Center for Medicare & Medicaid Innovation until at least 2020 or amend it to eliminate mandatory provider participation in Medicare models. This will allow an adequate transition period for the Transforming Clinical Practice Initiative grants aimed at lowering costs, improving health outcomes, and delivering more effective care.
Acknowledge the role of freestanding emergency centers and other health care delivery models as crucial to encouraging coverage innovation.
Protect the most vulnerable populations in this country by making sure Medicare, Medicaid, and CHIP remain available and solvent for current and future generations.
“ACEP looks forward to working with the new Congress and the Trump administration to cultivate a health care system that expands access for all patients, encourages innovation, and ensures the continued availability of health care providers,” said Dr. Parker. “No one in this country should ever be without necessary care because of an inability to afford it.”
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