Washington Debrief: President Trump Takes Two Executive Actions Impacting Healthcare

Jan. 23, 2017
President Trump on Jan. 20 signed an executive order that could open the door for federal agencies to curtail some aspects of the Affordable Care Act.

New Administration Update

President Trump Took Two Executive Actions Impacting Healthcare

Key Takeaway: President Trump and his senior leadership took two executive actions impacting healthcare. 

Why it Matters: President Trump on Jan. 20 signed an executive order that could open the door for federal agencies to curtail some aspects of the Affordable Care Act. In particular, the order aims to reverse "unwarranted economic and regulatory burdens" resulting from the ACA. Many aspects of the ACA are engrained in statute, so at this point it is still unclear exactly what actions agencies can take without an act of Congress. 

A second executive action described in a memo from the President's chief of staff calls for a freeze on pending regulations. The freeze applies to regulations that have been sent to the Federal Register but have not yet been published, as well as, those have been published but have not yet taken effect.

The new White House website is up and running, but content is still being populated. Those interested in signing up for updates from the new administration can do so at the homepage.

HHS Nominee Discusses EHRs, Telehealth Before Senate Committee

Key Takeaway: President Trump’s nominee to be the Secretary of Health and Human Services (HHS) appeared before the Senate Health, Education Labor and Pensions Committee last week.

Why It Matters: A health IT advocate during his time in the House, Dr. Tom Price (R-GA-6), nominated by President Trump for serve as the Secretary of HHS, has begun his Senate confirmation hearings. Among the many topics discussed included the Meaningful Use program, EHRs, telehealth and reducing the regulatory burden on healthcare providers.

During Wednesday’s hearing, Dr. Price was asked by Senator Bill Cassidy (R-LA), a fellow physician, about what can be done to reduce the concerns about electronic health records negatively impacting the provision of care and about the Meaningful Use program pushing doctors into retirement. While Dr. Price acknowledged that the documentation burden on clinicians is often cited as a pain point, he noted that EHRs are important for innovation and are a valuable tool to create a complete health history of a patient. Dr. Price went on to say that the government’s role should be to facilitate interoperability, ensuring that the systems talk to each other. He also suggested that the government work with clinicians to understand what can actually be measured, so alleviate unnecessary documentation for quality reporting.

Committee Chairman Lamar Alexander (R-TN) told Dr. Price that there is bipartisan interest in EHRs and the Meaningful Use program. Chairman Alexander expressed is specific concern about what has been put forth for Stage 3 of Meaningful Use and cited concerns about the program’s timeline.

Senator Tim Scott (R-SC) asked Dr. Price about the future of telemedicine. Dr. Price answered that telehealth is an exciting invention, especially useful to improve access to care in rural and underserved areas. Dr. Price suggested supporting policies that may accentuate the use of telehealth, reminding the Committee that today providers often shoulder the cost of providing telehealth services instead of being reimbursed through federal programs.

Dr. Price is scheduled to appear before the Senate Committee on Finance on Tuesday, January 24th at 10:00 a.m. ET. The Committee is likely approve his nomination and refer it to the Senate floor for consideration by the full Senate.

Quality Update

eCQM Changes Coming

Key Takeaway: CMS announced several changes to their electronic clinical quality measures (eCQM) policies.

Why it Matters: The Centers for Medicare and Medicaid Services (CMS)  announced plans to make several positive changes to the electronic clinical quality measures (eCQMs) reporting policies for hospitals. CHIME has consistently sought a shorter reporting period, fewer measures, less duplicity among reporting requirements, and an overall lessening of reporting burdens. In a blog post last week, CMS recognized that providers face significant challenges, including transitioning to new IT systems or upgrading existing systems. Here are some of the key changes the agency announced:

  • For 2016 Reporting Year:
    • Extending the reporting deadline from Feb. 28 to March 13
  • For 2017 Reporting Year, potential changes will be included in the Inpatient Prospective Payment System proposed rule, expected in late spring. The agency indicated that it will address:
  • Hospitals transitioning to new EHR systems or products;
  • Upgrading to EHR technology certified to the 2015 Edition;
  • Modifying workflows;
  • Addressing data element mapping; and
  • The time allotted for hospitals to incorporate updates to eCQM specifications in 2017.
  • CMS is also considering to propose in future rulemaking to modify the number of eCQMs required to be reported for 2017, as well as to shorten the eCQM reporting period.

Interoperability Update

Key Takeaway: Office of the National Coordinator for Health Information Technology (ONC) announced more challenge winners last week.

Why it Matters: ONC announced the Phase 2 winners for the Consumer Health Data Aggregator Challenge and the Provider User Experience Challenge. ONC designed these challenges to spur the development of market-ready applications (apps) that would enable consumers and providers to aggregate health data from different sources into one secure, user-friendly product using Fast Healthcare Interoperability Resources (FHIR®).

Alternative Payment Models Update

Key Takeaway: CMS announces announced over 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017.

Why it Matters: In a press statement last week, CMS announced in 2017, there are:

  • Over 359,000 clinicians participating in APMs
  • More than 12.3 million Medicare and/or Medicaid beneficiaries served
  • 572 ACOs across the Shared Savings Program, Next Generation ACO Model and CEC Model
  • 131 ACOs in a risk-bearing track, including in the Shared Savings Program, Next Generation ACO Model and CEC Model
  • 2,893 primary care practices participating in CPC+

CMS states that their work in expanding these models of care has been driven by:

  • CMS’s work in developing and expanding new payment models through the Innovation Center is guided by the following core principles:
  • Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs.
  • Engaging with and listening to consumers, health care providers, and other stakeholders allowing for open and transparent dialogue, including through the appropriate use of notice-and-comment rulemaking and ombudsmen.
  • Evaluating results based on appropriately scoped and sized model tests and advancing best practices based on their impact on health care quality and cost. We look forward to continuing to work with diverse stakeholders to achieve better care for patients, better health for our communities, and lower costs through improvement for our healthcare system.