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The Tide is Turning in DC: What Will Be the Impact on Healthcare?

Posted on Wed, Dec 28, 2016
The Tide is Turning in DC: What Will Be the Impact on Healthcare?

By Jeff Slepin, MD, MBA, FACEP

The past year, the nation’s attention and the news cycle has been dominated by the tumultuous election of Donald Trump and the change in power in Washington and in individual states.

While some focus on the macro-view of potential changes, a significant number of voters and others tend to focus only on how these potential changes affect their lives and their family on an individual basis. This is particularly true for such important aspects as employment, taxes, social issues and healthcare.

The Affordable Care Act and its rollout over the past six years has certainly engendered positive and negative changes, and corresponding emotions, across the political spectrum. Large segments of the population, particularly those who have obtained subsidized access to health insurance, those in the younger, healthier age brackets who chose to purchase coverage to avoid penalties, and providers, have strong opinions about the act. Providers have experienced changes, with more scheduled to be rolled out, with continuing reimbursement challenges, insurance company influence, and the shift from payment for services rendered to payment for value models.

Change in healthcare is challenging for both providers and patients. The shift to Republican control of all three branches of government can be viewed from a variety of perspectives that are too numerous and potentially volatile to mention here. What is clear, however, is that change in Washington does not occur overnight. An article in The Atlantic explained, “…the press takes [Donald Trump] literally but not seriously; his supporters take him seriously, but not literally.”

This astute summation leads me to conclude that changes in the Affordable Care Act’s impact on patients and providers may not be as dramatic, nor occur as quickly, as voiced by President-Elect Trump and other Election Day victors.

Thus, any changes in the ACA will likely be slow to come, as opposed to the familiar “repeal and replace” mantra.  Hopefully, cooler heads and common sense will prevail, and beneficial aspects of the ACA, such as coverage of pre-existing conditions, students and young adults covered under their parents’ policies to age 26, and expansion of the covered population through Medicaid and other programs, will be continued.

What will continue to be key to assuring access to healthcare for our growing population, especially the baby-boomer generation, which will use the majority of resources in the next 30 years, is:

  • Realignment of incentives through innovative delivery systems
  • Shared risk and responsibility (for both providers and patients)
  • Elimination of wasteful spending
  • Tort reform
  • Development of truly “best practices” and realistic metrics that will influence care
  • Assuring the viability of community hospitals (healthcare should be local as much as possible)
  • Increased funding for graduate medical education (as part of an effort to address the current and forecasted shortage of providers)
  • A shift to value-based payment

I’ve read a number of posts on physician education websites with varying opinions on the future of healthcare. The majority, unfortunately, were negative in tone, perhaps related to the political views of those who opined.

One encouraging sign, though, is the nomination of Rep. Tom Price of Georgia to serve as Secretary of Health and Human Services. I met Dr. Price, an orthopedic surgeon, in his congressional office last year while on a lobbying trip to Capitol Hill. I found him to be warm, gracious, down-to-earth and genuinely interested in the welfare of patients and providers alike. Should he maintain this approach, it bodes well for a shift in the focus on healthcare delivery back to the ultimate and most important aspect: the sacred interaction between provider and patient.

Let’s keep our fingers crossed that Dr. Price considers these interests in his decisions and that he works to change the culture of HHS to be more considerate of patient care while continuing to balance the fiscal realities of delivering healthcare in our country.

Dr. Jeff Slepin

M. Jeffrey Slepin, MD, MBA, FACEP, is a residency-trained, ABEM-certified emergency physician who has been a Regional Medical Director for EmCare since 2003. He attended Emory University and completed his medical education at the Medical College of Virginia. Following his residency at the University of Florida Health Sciences Campus in Jacksonville, he practiced in Virginia and Florida. He obtained his MBA at the College of William and Mary Graduate School of Business prior to joining EmCare.

The views and opinions expressed here are those of the authors and do not necessarily reflect the positions of EmCare, Inc., or Envision Healthcare.


Rural Hospitals and Clinicians Await Washington’s Next Move

Posted on Thu, Nov 17, 2016
Rural Hospitals and Clinicians Await Washington’s Next Move

Healthcare facilities in rural areas have increasingly been under pressure. Access to care, physician shortages, shrinking reimbursement and gaps in insurance coverage have plagued patients in “Middle America.” On Election Day, rural Americans disproportionately voted for Donald Trump. Now, rural residents and the healthcare industry are anxious to see what direction the new administration will take to address the concerns of these citizens.

Twenty percent of the nation lives in rural America, and according to this year's exit polls, rural voters made up 17 percent of the electorate, according to the National Rural Health Association. Now that Rural Americans seemingly have Washington's ear, hospital administrators across the country trying to guess what impact Trump will have on the industry, particularly if he will work to repeal the controversial Affordable Care Act (ACA).

In a recent Modern Healthcare article, Kaiser Permanente CEO Bernard Tyson said that while Trump has said that he wants to repeal the ACA, the president-elect "seems to agree that everyone ought to have affordable, high-quality care and access.”

Dr. Rebecca Parker, president of the American College of Emergency Physicians (ACEP), said in a recent press release that emergency physicians are committed to working with the new Congress and President to address the critical issues facing patients. ACEP is focusing its efforts on putting pressure on the insurance industry to address gaps in coverage.

“State and federal policymakers need to ensure that health insurance plans provide adequate rosters of physicians, affordable deductibles and co-pays and fair payment for emergency services,” said Dr. Parker.

Emergency physicians represent only 4 percent of all doctors, but provide care for 28 percent of all acute care visits, 50 percent of all Medicaid and CHIP visits and 67 percent of acute care given to uninsured patients, according to ACEP.

Rick Pollack, President and CEO of the American Hospital Association, released a statement last week, reasserting his organization's goals: "Amid the changing political landscape, our priorities remain the same – advancing the transformation of healthcare, ensuring access to coverage, preserving adequate resources for healthcare, protecting patient access to care, enhancing the quality of care and patient safety, and making healthcare more affordable."

EmCare treats for more than 1.5 million patients in 170 rural hospitals around the country, requiring efficiency, alignment, creativity, targeted recruiting, and skilled resource management. Because of the unique climate at these client sites, the company has dedicated an entire division to managing rural, community and other small-volume hospitals and medical centers.