With the narrow passage of the American Health Care Act in the House Thursday as the first step to repeal and replace major components of the Affordable Care Act, some healthcare information technology efforts may be eventually refocused at the nation's healthcare organizations.
The vote to pass the bill could increase uncertainty among healthcare organizations about revenue, thus resulting in hesitance to commit to large capital purchases or cause changes in priorities, some industry watchers say. Because of the uncertainty about where federal health policy is going, providers may looking to short-term solutions that increase their flexibility to adapt to changes. And long-term IT strategies need to be re-examined to ensure they meet the emerging challenges in healthcare.
HIT industry executives, however, noted that the House action was only the first step in a long legislative process that could take months to complete—or might completely fail.
“All of the current uncertainty and potential eventual undoing of regulations pulls away organizational resources that could otherwise be devoted to important priorities related to the quality and efficiency of care, including IT,” says Julia Adler-Milstein, associate professor at the University of Michigan’s School of Information.
Although the eventual fate of legislation remains uncertain, it’s clear that the rolls of the uninsured will grow in most scenarios. While the current House bill was pushed to a vote before the CBO could assess its financial impact, the office’s review of the original version of the bill in March predicted that 14 million people would lose health insurance immediately and as many as 24 million would lose coverage over the next 10 years.
Even if the AHCA is altered or fails to make it out of conference committee, the GOP has made clear it will take no steps to support the Affordable Care Act, which will reduce the number of those now covered by its health insurance provisions.
Growth in the number of uninsured patients will likely cause healthcare organizations to face increased unreimbursed costs, which could put pressure on large capital purchases, such as healthcare information systems.
However, most industry experts don’t expect any immediate changes in implementation decisions. That’s because HIT initiatives typically require long decision processes that take many months to complete, especially for implementations of major systems, such as electronic health records systems.
For the long term, providers and insurers may look to more flexible systems that could facilitate information exchange and expected changes in the market.
“If I try to stretch to see a silver lining, perhaps as people lose insurance, there will be greater demand for innovative, tech-enabled models of care delivery for uninsured and underinsured,” says Adler-Milstein.
While the bill passed by the House would repeal premium subsidies, that would not happen for three years so there will be a continued need for IT to connect insurance carriers with the health insurance exchanges, says Chris Condeluci, principal in the CC Law & Policy law firm in Washington.
Under the bill in its present form, fixed tax credits will be available in 2020 in the individual market, subject to current premium subsidies. The administration wants private companies to facilitate assimilation of credits and link the insurers into that process, which IT will support, Condeluci adds.
Some experts suggest providers should be redoubling efforts to try to reduce costs from the system as they deal with potential reductions in revenue, and that has implications for IT, which will need to play a larger role in improving care delivery and cutting costs.
For example, Jeffrey Hulburt, president and CEO of Beth Israel Deaconess Care Organization, Boston, questioned the adequacy of the AHCA's risk pool funding and whether the amount allocated would be enough to cover the high risk pool. “That’s why our focus should instead be on innovative models and approaches that enable us to reduce the cost of healthcare so that it isn’t so expensive to begin with,” Hulburt says.
“The current bill is primarily focused on the insurance and coverage component of our healthcare system, along with redistributing the cost burden. To make this bill truly effective, it needs to address how to bring the unit cost (or per capital cost) down and improve quality outcomes,” says Sach Jain, CEO of Carrum Health, a vendor that uses IT to broker bundled health arrangements between providers and payers.
The need for data integration capabilities will need to grow in the coming months, predicts Bruce Carver, associate vice president of payer services for MedeAnalytics, a company that offers healthcare analytics tools.
“Regardless of what happens next, collaboration between payers and providers around how to improve outcomes (quality) and reduce costs must be a priority,” Carver says. “The alignment of financial incentives between provider and payers are required to ensure that both are aligned on strategic management. This means that data is even more important and it must be made actionable.”
Most healthcare IT industry watchers say it’s too early to determine the bill’s impact on the industry.
For example, nembers of the Senate have said they plan to craft their own version of a repeal-and-replace bill, said Sen. Lamar Alexander, (R-Tenn.). “We’ll take whatever good ideas we find there that meet our goals.” The Senate also is expected to rely heavily on an assessment by the Congressional Budget Office (CBO), a non-partisan office that assesses the budgetary and societal impact of proposed bills.
If the Senate passes a different version of a repeal-and-replace bill, its version and that just passed by the House would go to a conference committee, which would aim to harmonize differences between the two bills. Then, that unified version would have to be passed by both the House and Senate, and then finally signed by President Trump to become law.
Because of the long legislative process, it’s difficult to predict the exact effects on healthcare IT, says Robert Tennant, director of health information technology policy for the Medical Group Management Association.
“With 217 votes, all Republican, the AHCA passes the House,” Tennant says. “The final passage of the bill into law is still uncertain. In terms of implications to HIT, it’s very difficult to predict. We’ll be watching the progress of the AHCA through the legislative process and assess the potential impact on medical groups and technology as the debate continues.”
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