Will Trump presidency disrupt current health IT policy?
Healthcare IT executives are anxiously looking for a sense of how HIT policy will turn under the Trump administration.
Some of the president-elect’s positions on healthcare are well-known, such as his stated intent to repeal and replace the Affordable Care Act with health savings accounts, and working with Congress to create a “patient-centered healthcare system that promotes choice, quality, and affordability.”
But, when it comes to Trump’s approach to health IT, little is known about the kinds of changes and policy prescriptions he would bring to the White House.
Nonetheless, if the political platform adopted in July at the Republican National Convention in Cleveland is any indication, a Trump administration will seek to further the positive impact that health IT has had on the healthcare industry.
“We applaud the advance of technology in electronic medical records while affirming patient privacy and ownership of personal health information,” states the 2016 Republican platform.
“The nice thing about health information technology is that, for the most part, it is a bipartisan issue,” says Robert Tennant, director of Health IT Policy at the Medical Group Management Association.
However, Tennant warns that a top priority of the new Trump administration and Republican-controlled Congress will be repealing the Affordable Care Act, and Tennant suggests that “could have the effect of reducing the willingness of congressional Democrats to engage across the aisle on healthcare issues.”
Still, Jeff Smith, vice president of public policy for the American Medical Informatics Association, does not anticipate that the incoming Trump administration’s policies would “do much to deter the trajectory of health IT use in our healthcare system.”
At the same time, Smith observed that when it comes to the Obama administration’s national research priorities—such as the Cancer Moonshot and Precision Medicine Initiative, which heavily leverage HIT— “it’s completely unclear as to whether they will be given the time of day in a Trump administration.”
However, from a HIT perspective, “both parties recognize the roles that health IT and interoperability that leads to information exchange play in securing healthcare transformation,” says Tom Leary, vice president of government relations at the Healthcare Information and Management Systems Society.
Leary, who leads the organization’s public policy initiatives and outreach to Congress and federal agencies, contends that the industry’s transition from fee-for-service to value-based reimbursement requires universal adoption and use of electronic health records to achieve delivery system reform and better patient outcomes—that reality is recognized by both Democrats and Republicans.
According to Leary, health IT is now “woven into the fabric” of the nation’s healthcare infrastructure, with more than 95 percent of hospitals and nearly 80 percent of physician offices using certified EHR technology.
“Data sharing and particularly quality data reporting will be a very important component” of the success of providers in navigating the challenges of “moving from volume to value,” he adds. “In order for the new Quality Payment Program known as MACRA to be successful, we have to continue the focus on interoperable health IT solutions.”
Given MACRA’s strong bipartisan support in Congress, Leary does not foresee a rollback in either the legislation or the use of health IT by a Trump White House.
Still, he does anticipate that Trump’s focus on reducing burdensome government regulations could result in a review by his administration of the Enhanced Oversight and Accountability Rule, which was released last month by the Office of the National Coordinator for Health Information Technology.
The final rule codifies modifications and new requirements under ONC’s Health IT Certification Program, intended to protect public health and safety, as well as strengthen the accountability and transparency of certified HIT.
“Some organizations feel like it’s a regulatory overstep,” says Leary. “Given the fact that Mr. Trump has talked about reviewing regulations, I would think the rule might be reviewed early on in his administration.”
“As with every administration, much of the healthcare activity will occur at the regulatory level,” observes Tennant. “We will be watching closely to see who president-elect Trump nominates as HHS secretary and as heads of the key HIT-related departments such as ONC, CMS and (the HHS Office of Civil Rights).”
Tennant believes that the scope of reporting for programs such as Merit-Based Incentive Payment System (MIPS) could pique the Trump administration’s interest in addressing provider burdens in complying with those requirements.
Leslie Krigstein, vice president of congressional affairs for the College of Healthcare Information Management Executives, says it is a top priority for both Democrats and Republicans to pass the 21st Century Cures Act legislation into law this year during the lame duck session. The 21st Cures Act is a package of biomedical innovation bills that, among several other provisions, seeks to improve health IT interoperability.
“It’s the No. 1 priority, and Republicans in the Senate have promised to move forward on Cures, but the question is whether it maintains its priority status for the lame duck session,” adds Leary.
AMIA’s Smith sees strong bipartisan support for health IT in the Republican-controlled House and Senate. The Senate health committee, in particular, has a well-deserved reputation for bipartisanship in this technology area, he believes.
In that spirit, Sen. Lamar Alexander (R-Tenn.) chairman of the Senate health committee and ranking member Sen. Patty Murray (D-Wash.) issued a joint statement in late September committing to finishing their bipartisan work this year on a Senate version of the 21st Century Cures Act.
“We’ve been working for a year and a half on behalf of patients and scientists, and we are committed to getting a result this year that will lead to lifesaving medical breakthroughs and advance President Obama’s Precision Medicine Initiative and Vice President Biden’s Cancer Moonshot,” stated Alexander and Murray.
“As we’ve seen with the Cures bill and other recent efforts, HIT as a lever to drive improved care and decreased cost is an issue that both Dems and Republicans can rally around,” adds MGMA’s Tennant.
According to Smith, the co-sponsorship of the Improving Health Information Technology Act (S. 2511) by Sens. Bill Cassidy, MD (R-La.) and Sheldon Whitehouse (D-R.I.), which included provisions for a government-sponsored HIT rating system, is also a good example of how Democrats and Republicans work well together on technology issues.