Healthcare Highlights of 2016—and Predictions for the New Year

SUMMARY That a new administration will take steps in 2017 to repeal the Affordable Care Act (ACA) is fairly certain, but eligible anesthesia providers should forge ahead with their plans to report under the Quality Payment Program mandated by the Medicare Access and CHIP Reauthorization Act (MACRA). Regardless of what happens to the ACA, MACRA and the healthcare sector's shift to value-based care are expected to continue. We also present predictions for 2017 from a report by PricewaterhouseCooper's Health Research Institute.

Looking back on 2016, one need only look as far back as November to find the year's most significant regulatory development. Donald J. Trump's election as president and his vow to repeal the Affordable Care Act (ACA) of 2010 have triggered a mountain of speculation about the fate of the historic and controversial legislation, a hallmark of President Barack Obama's administration.

That a Trump administration will attempt to repeal the ACA appears likely; how quickly a repeal could be accomplished and what would replace it are less well-known. A healthcare position statement on Trump's website calls for eliminating the individual mandate, allowing the sale of insurance plans across state lines, making healthcare premiums fully tax deductible, promoting the use of health savings accounts (HSAs), requiring healthcare price transparency to enable patients to "shop" for services and providing Medicaid block grants to states.

However, indications are that a repeal of the ACA could take years, in part because it would mean dismantling the complex web of federal interagency cooperation created to implement the ACA's provisions, attorney Beth Halprin said in Fierce Healthcare.

In addition, the tax deductions and HSAs proposed by Trump would help primarily wealthier individuals and "do little or nothing for the millions of people now receiving tax credits for coverage through the ACA, who often pay little in taxes and receive little benefit from deductions and have little to save in HSAs," Timothy Jost writes in Health Affairs Blog.

Efforts to repeal the ACA are also likely to meet with resistance from hospitals. The American Hospital Association and the Federation of American Hospitals contend that a repeal would cost hospitals $165.8 billion by 2026 and "trigger 'an unprecedented public health crisis,'" including massive service cuts and hospital closings. Modern Healthcare reports that the two organizations have sent letters to Trump and Congress arguing that "Losses of this magnitude cannot be sustained and will adversely impact patients' access to care, decimate hospitals' and health systems' ability to provide services, weaken local economies that hospitals help sustain and grow and result in massive job losses."

Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, put it another way on Twitter: "Taking health care coverage away from people is easy. Creating coverage for people is hard. We did the hard."

Value-Based Care Will Endure

While the ACA's fate remains unknown as the year closes, value-based care appears to be here to stay. A repeal of the ACA would not be a repeal of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which lays the foundation for the Quality Payment Program and the transition to value-based payment. "While there is a significant chance that the specific mechanics of reform may change, the interest in and demand for value-based care will persist on both sides of the aisle," Emme L. Deland and Jonathan Gordon of New York Presbyterian Hospital write in a November 15 NEJM Catalyst blog post.

In a conference call shortly after the election, Slavitt advised clinicians to "plow ahead and [don't] use anything that happened in the election as a distraction," stressing that commitment to MACRA remains strong.

Other Predictions for 2017

What lies ahead? PricewaterhouseCooper's (PwC) Health Research Institute reviews some of the major forces that will shape healthcare in the coming year in its report, Top health industry issues of 2017: A year of uncertainty and opportunity.

1. Under a new administration, the fate of the ACA remains unclear. Efforts to repeal the ACA would likely be followed by a period of transition. "This isn't flipping a switch," David Merritt of America's Health Insurance Plans says in the report. "You can't move from one approach to another just by passing legislation. . . That's why the real question will be what happens in 2018 and beyond."
2. Pharma's new strategic partner? Patients. Patients, faced with increasing financial responsibility for healthcare, will look to drug companies to provide added assurance that their products are worth the costs. Pharmaceutical companies will attempt to engage patients through apps and other services to demonstrate value and satisfy regulators.
3. Easing the training wheels off value-based payment. Physicians will need a good sense of their quality and cost effectiveness because the onus is on them. They might consider partnerships and alliances that will help them acquire the clinical skills and technology infrastructure needed to drive robust analytics, segment patient populations and provide customized care.
4. Insert your card here for healthcare. Health systems will begin the sorely needed process of streamlining and standardizing their payment systems to facilitate more satisfying patient experiences. Healthcare providers that put new systems in place should create a dedicated group to keep the systems up to date following implementation.
5. It's time to prepare for emerging technologies. Healthcare organizations will begin to embrace technologies ranging from artificial intelligence to virtual reality devices for reducing patient stress to drones to deliver supplies. Providers can achieve the best return on investment by applying these technologies in coordination with each other and in coordination with services provided by human beings.
6. The battle against infectious diseases sparks invention. "In 2017, millions of dollars will be earmarked for drug and device industry projects aimed at combating the spread of infectious diseases. At the same time, industry and regulators are working together to develop rapid diagnostics aimed at infectious diseases," the report states. Pharmaceutical and device manufacturers will begin to partner with public agencies to facilitate the development and marketing of innovations, and smartphones will support dissemination of data to public health agencies about outbreaks and disease patterns in geographic areas.
7. Nutrition takes a more central role in health. Increasing awareness of diet's role as a factor in health and healthcare costs will drive innovations, such as screening questions related to food insecurity embedded in electronic medical records. "Primary care teams of the future likely will be comprised of many different professionals, including dietitians and nutritionists. Primary care doctors cite these experts as among those they most want on their teams, and consumers echo their enthusiasm," according to the report.
8. Drug companies put the brakes—gently—on prices. "Public demand for drug pricing accountability, pushback from drug purchasers and the potential for new price control regulations are prompting drug company executives to embrace voluntary codes of conduct to rein in the kinds of pricing practices that have led to congressional shaming, executive resignations and global drug access barriers," PwC states. Drug manufacturers may become more transparent about pricing to build patient trust.
9. A year of new partnerships and collaborations. Ongoing mergers and acquisitions will continue to characterize the current wave of consolidation within the industry, but 2017 might also see an increase in alternative transactions, such as joint ventures, partnerships, strategic alliances and clinical affiliations. These strategic partnerships require a strong value proposition, which "hinges on first ensuring the deal aligns with overall strategy, defining a governance structure and operating model to support it and considering how the deal's benefits will be marketed to consumers."
10. Medical students prepare to enter a value-based world. Physicians of the future will need a new toolbox of skills in addition to clinical competency, including leadership and team management skills, to function effectively in a value-based environment. Medical schools, residency programs and continuing education developers should look for ways to incorporate learning opportunities into their offerings in such areas as Six Sigma, systems engineering and non-clinical operations such as central sterile supply.

Positive Signs

We close 2016 with the good news from Health and Human Services (HHS), released on December 12, that approximately 125,000 fewer patients died due to hospital-acquired conditions from 2010 through 2015, resulting in a cost savings of more than $28 billion.

The finding comes from the Agency for Healthcare Research and Quality's (AHRQ) National Scorecard on Rates of Hospital-Acquired Conditions, which attributes the gains in part to the patient safety provisions of the ACA. The ACA "gave us tools to build a better health care system that protects patients, improves quality, and makes the most of our health care dollars," HHS Secretary Sylvia M. Burwell said in a statement. AHRQ's steady dissemination of patient safety research and information also contributed. "Now we're seeing these investments continue to pay off in terms of lives saved, harm avoided and safer care delivery overall," said AHRQ director Andy Bindman, MD.

Other good news comes from the American Medical Association, which reports that opioid prescriptions fell by 10.6 percent from 2013 to 2015 due to increasing physician awareness of opioid abuse, improvements in opioid prescribing practices and expanded access to naloxone. Physicians checked state prescription drug monitoring programs (PDMPs) nearly 85 million times in 2015, a 40 percent increase from 2014, according to an AMA survey. Though opioid abuse remains a serious public health problem, these steps offer encouragement.

One thing we can predict with certainty: Healthcare will continue to be an exciting and rewarding place to be, despite the uncertainty that lies ahead.

Sending our best wishes for a happy, healthy and productive new year,

Tony Mira
President and CEO