Two Healthcare Initiatives Fly Under the Radar

By
Original story posted on: December 9, 2020

Both are expected to impact on clinical and administrative elements of U.S. healthcare.

I keep saying this, every week, but I really think that Congress will finally get it done. Everyone – the House, the Senate, the planets – seem to be aligning behind a $900 billion COVID relief package attached to a government funding bill.

We’ll see if Congress can agree on it over this coming week. Hope springs eternal. 

COVID package aside, let’s talk about what else may happen in the next 12 months, as far as healthcare policies go.

Whether Democrats or Republicans emerge as the majority in the Senate after Georgia’s run-off election, the Biden Administration is not expected to be able to pass any significant progressive health reform measures, such as the Medicare-like public option, because the government will still be more or less divided.

In the meantime, some states are expected to move ahead with their own public options, knowing that a Biden Administration will be friendly in terms of granting waivers on how Medicaid and other federal money can be spent. Washington State is expected to roll out its public option this coming year; the New Jersey legislature introduced a public option late last month, and Connecticut and Colorado will both attempt to pass public options that were tabled last year.

The Biden Administration will do what it can administratively to boost the Patient Protection and Affordable Care Act (PPACA) exchanges, like expanding eligibility for subsidies and increasing public outreach. This past weekend, Biden chose California Attorney General Xavier Becerra to lead this effort as Secretary of the Department of Health and Human Services (HHS). The Biden Administration will also push back on Trump-era initiatives such as short-term health plans that did not have the same PPACA benefits and protections.

Biden will also work quickly to centralize the management of COVID-19 at the federal level. Biden announced this week that he would ask Americans to wear masks anytime they are outside their homes for his first 100 days. He’s offered Dr. Tony Fauci to stay in his role as director of the National Institute of Allergy and Infectious Diseases, and as a member of the administration’s COVID task force. During his meeting with Dr. Fauci, Biden said that they talked about how the economy does not have to be shut down if Americans follow through with other safety protocols to prevent the spread of the virus.

Ironically, the most significant healthcare policy shifts that will happen over the coming year are two initiatives that are not making national headlines, though they are expected to have tremendous impacts on both the clinical and administrative elements of U.S. healthcare. Those two policy initiatives are interoperability and transparency, both of which have been years in the making over a number of administrations, with bipartisan support.

Interoperability’s roots go back to the George W. Bush administration and the meaningful use regulations passed during the early Obama years. Interoperability rules will require that hospitals be able to seamlessly exchange individual patient data with other facilities, as well as with third parties that are expected to create apps and develop other solutions that will put healthcare records in the hands of consumers.

Transparency is based on a PPACA provision, but has had significant pushback from the Trump Administration over the past few years. Transparency requires hospitals and health plans to publish all their data on how much healthcare services cost, how much is being billed, and how much is being paid.

Both interoperability and transparency hold the promise that all this clinical and pricing data will be used to improve America’s health and bring down the cost of care.  

However, over the next 12 months, both those initiatives, and their related regulations, will require heavy lifts in terms of implementation from an already exhausted and resource-stretched healthcare industry.

Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Related Articles

  • PEPPER Adds Spice to Reporting of New Regulations
    Big news to end the year. The final Monitor Mondays broadcast of the year is normally when I announce my Hirsch’s Heroes. But this year, it would be inappropriate to single out any individuals, when so many in healthcare go…
  • New Regulations Herald a Season of Changes
    Stark regulations among new regulatory changes. This has been one of the busiest weeks of regulatory changes in recent memory. Last week, the U.S. Department of Health and Human Services (HHS) issued its fourth amendment to the Declaration of the…
  • OPPS Final Rule Issued, Heralding Beginning of the End for Inpatient-Only List
    The list will be eliminated over the course of three years. Federal officials unveiled the 2021 Outpatient Prospective Payment System (OPPS) Final Rule this week, and it heralds a long-awaited development in the initialization of the dissolution of the Medicare…