On the campaign trail and as President-elect, Donald Trump and his surrogates have hinted at the direction he will take the nation’s healthcare system, and speculation has been rife about what shape these policies might ultimately take. With Trump being sworn in today as the 45th President of the United States, health information technology leaders are hoping the political agenda of the new administration will soon become clearer.
While repealing the Affordable Care Act appears to be the top healthcare priority for the incoming Trump administration and congressional Republicans, health IT groups are looking beyond the ultimate fate of Obamacare and are seeking tech reforms that directly impact their respective members.
According to Robert Horne, executive director of Health IT Now (HITN), so much of the political discourse in Washington these days is focused on repealing the ACA and what could replace it. However, Horne’s organization has not taken a position either way in the debate over Obamacare, which he sees as fundamentally an issue over health insurance coverage and access.
“Those issues are better dealt with by payers, providers, and consumer and patient advocates,” he contends.
“The repeal conversation is very much focused on insurance reforms, and a lot of what has driven health IT activity is much more predicated on delivery system reforms—like alternative payment models, of course Meaningful Use and the Merit-Based Incentive Payment System,” adds Jeff Smith, vice president of public policy for the American Medical Informatics Association (AMIA).
Leslie Krigstein, vice president of congressional affairs for the College of Healthcare Information Management Executives (CHIME), makes the point that the ACA and HITECH Act are two very different statutes and that CHIME has “steered clear” of the “partisanship that has surrounded the ACA since its inception.”
Nonetheless, Krigstein says that her organization is monitoring how the Trump administration and Republican leaders in Congress decide to move forward regarding Obamacare to see if there might be “trickle-down implications” for CHIME’s members.
Still, Horne argues that Washington’s renewed focus on healthcare reform in the context of repealing outright the ACA or replacing the law’s major provisions is creating a tremendous opportunity for health IT groups to promote HIT policies that better serve providers and patients alike.
“Healthcare reform can serve as a platform to start rolling out some IT and data policies that we truly think will help transform healthcare like they’re transforming every other sector of our economy,” says Horne, who is encouraged by the fact that Rep. Tom Price, MD (R-Ga.), Trump’s nominee to serve as Health and Human Services Secretary, has sponsored legislation to ease the HIT regulatory burdens on providers. “I do think Price’s understanding of health IT as a practitioner really is a big asset,” he offers.
“We’ve turned many physicians and other providers into data entry clerks, and it detracts from their productivity and their ability to provide quality care,” Price told the Senate health committee on Wednesday during a nomination hearing.
On the issue of electronic health records and the Meaningful Use program, Price said he’s had “more than one physician” tell him that the “final regulations and rules related to Meaningful Use were the final straw for them” causing them to quit the program.
“Dr. Price has been a sponsor and a leader in the Congress in trying to address some of the problems with Meaningful Use,” notes Robert Tennant, director of health IT policy at the Medical Group Management Association (MGMA), who says that if Price is confirmed, he would be the first clinician to serve as HHS Secretary since Louis Sullivan, MD, during President George H. W. Bush’s administration.
“We in the physician community are hopeful that we’ll have a very sympathetic ear when we go and talk to HHS about trying to restructure some of these federal requirements,” comments Tennant.
Likewise, AMIA’s Smith asserts that Price “believes the current programs need to be further reformed,” and that if he’s confirmed as HHS Secretary, he will “initially focus on the reporting burden” of health IT for doctors and nurses. Tennant adds that MGMA is optimistic Price will “continue to hold the torch for the administrative burdens associated in healthcare, not just the clinical side—so, there’s plenty to be done in terms of HIT.”
Although Price is, in Krigstein’s words, “very provider friendly,” she believes he has a strong recognition that “there is a role for technology—for EHRs—as we move forward in the delivery of healthcare.”
If Price is confirmed by the Senate to head HHS and empowered by the Republican-controlled Congress, Horne believes the Trump administration will be well positioned to make some far-reaching health IT reforms. He points to the 21st Century Cures Act, which was enacted last month, as a major step toward addressing the healthcare industry’s HIT interoperability challenges.
Blair Childs, senior vice president of public affairs for Premier, an alliance of hospitals and other providers, surmises that, in light of the Republican leadership in Congress’ passage of the Cures Act late last year, they “will continue to focus on health IT, but much more from an interoperability standpoint, which is probably the biggest challenge in healthcare today.”
The Cures Act supports interoperability through several provisions, including the prohibition of information blocking and authorization of penalties of as much as $1 million per violation. In addition, the law codifies new authority for the Office of the National Coordinator for Health IT to address interoperability through additional conditions of certification for HIT developers related to: access, use, and exchange of electronic information; usability, security, and business practices; real-world testing; as well as publishing application programming interfaces.
“The Cures Act gives ONC a little bit more leverage in the marketplace than it previously had,” says Krigstein. Even so, Tennant observes that “most of the key HIT components of the Cures Act have to be implemented by the Secretary of HHS.” If Price leads the department, he believes it will be his “spin on what’s required in the statute—which is going to make the difference.”
According to Tennant, the HHS Secretary has “enormous flexibility,” and Price “could use Cures as a springboard or foundation for an aggressive movement in this area.”
The Senate Committee on Finance has scheduled a confirmation hearing to consider Price’s nomination to be HHS Secretary for January 24.
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