January 19, 2017

News Alert: Approaching Inauguration Day, 30 Percent Predict PPACA Repeal

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With the inauguration of Donald Trump as the 45th U.S. president getting underway this morning in Washington, D.C., 30 percent of healthcare professionals believe that the Patient Protection and Affordable Care Act (PPACA) is likely to be repealed.

The survey performed by Monitor Mondays, the live Internet broadcast from RACmonitor, was conducted during Monday’s broadcast. Listeners were asked if they thought that President Barack Obama’s signature legislative achievement, passed in 2010, would be repealed or partially repealed. Thirty percent responded that in either case, there would be a repeal, with 13 percent predicting a complete repeal and 17 percent predicting a partial repeal.

“Monitor Mondays listeners are savvy healthcare professionals and are looking to get the most updated and accurate information from our expert panelists,” wrote Monitor Mondays senior correspondent Nancy Beckley of Nancy Beckley and Associates, who authored the online poll. “Given the popular news and cable news focus on the healthcare exchanges and the personal mandate in the repeal-Obamacare debate, we wanted to check the temperature of our listeners and what they see in their individual crystal balls, through their healthcare expertise filter.”

Other Monitor Mondays correspondents have predicted that the anti-fraud, waste, and abuse provisions that are not popular in the mainstream media, cable, and radio talk shows are likely to remain in place. Such was the opinion of Monitor Mondays Compliance Correspondent Bret Bissey.

“Having been in the compliance space for the past 20 years, one of the consistent themes has been steady attention to high levels of enforcement regardless of political climate or party leadership,” said Bissey, senior vice president of compliance services for MediTrack, Inc. “My response to the question is that fraud and abuse enforcement should continue at its current pace in the future, based on the fact that the return on investment (ROI) on efforts to date has been so successful and that the Medicare Trust (Fund, which benefits directly from fraud settlements) needs these initiatives to continue to be solvent in the future.”

Monitor Mondays survey results came at a time, earlier this week, when the nonpartisan Congressional Budget Office (CBO) reported that at least 18 million people could lose their insurance coverage in the first year after the PPACA is repealed. Even as the inauguration is getting underway this morning, there is a cloud of uncertainty among Republican lawmakers over the yet-to-be revealed healthcare replacement plan that President-Elect Trump has said would cover “everybody.” Meanwhile, U.S. Rep. Tom Price (R-Ga.), Trump’s nominee for secretary of the U.S. Department of Health and Human Services (HHS), has yet to be confirmed by the Senate. Price, a former orthopedic surgeon, was among several other Republican lawmakers opposed to the implementation of ICD-10.

“It looks like 2017 is going to be one heck of a year in healthcare,” said Ronald Hirsch, MD. “The fate of the PPACA is unknown, and I will make no attempt to speculate.”

Hirsch, however, noted other healthcare initiatives that warrant attention, including the progression of bundled payments established by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.

“This year, acute myocardial infarction, hip fractures, and cardiac bypass surgery will join total joint replacement as mandatory bundles in select areas,” said Hirsch, vice president of R1 Physician Advisory Services, (which until just recently was known as Accretive Physician Advisory Services). “The good news for hospitals in the Comprehensive Care for Joint Replacement (CJR) program is that cost savings are relatively easy (to obtain) … one health system in Texas reported that they were able to cut costs by 20 percent, or over $5,500 per patient, with 34 percent of those savings coming from better pricing on the implants and 44 percent coming from reduction in spending on post-acute institutional spending.”

Hirsch, a contributing editor for RACmonitor, said another area to be monitored this year is the three-day skilled nursing home (SNF) wavier for the CJR hospitals.

“There are over 9,400 SNFs that qualify for the waiver,” Hirsch told RACmonitor. “Now the hospitals just need to figure out a way to compliantly get their patients to select one of these SNFs.”

Another area that Hirsch says that hospitals should monitor are the Recovery Audit Contractors (RACs). Auditing by the RACs and the Quality Improvement Organizations (QIOs) are expected to continue in 2017.

“I am also quite concerned about the Recovery Auditors in 2017,” Hirsch said. “The Office of Inspector General released a quite damning report in early December, which I addressed in an open letter that was posted to RACmonitor.”

Hirsch doesn’t see how CMS and Congress are going to ignore calls that he says are already coming from auditors and government watchdogs to start using data to increase audits on hospitals with high numbers of short inpatient admissions.  

While noting that the first total solar eclipse over the United States mainland since 1979 will occur this year, he nonetheless could not predict another event on the horizon: the promise of sub-regulatory guidance from CMS on the implementing Medicare Outpatient Observation Notice (MOON).

As organizers hope for an uneventful inaugural parade this morning, providers need to buckle up for what is expected to be bumpy road for healthcare in 2017.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the executive producer and program host of Monitor Mondays.

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