Healthcare Trade Groups Respond to Presidential Election Results, Comment on Next Steps
In the last few days following the Nov. 7 declaration that former Vice President Joe Biden would win the 2020 presidential election, industry trade groups took to releasing statements on what they’ll be paying close attention to during the transition to a Biden administration.
On the value-based care front, the Washington, D.C.-based National Association of ACOs (NAACOS), which represents “more than 12 million beneficiary lives through hundreds of organizations participating in population health-focused payment and delivery models in Medicare, Medicaid, and commercial insurance,” welcomed the President-elect and Vice-President-elect on Nov. 9. Writing in a statement published to the association’s website on Monday morning, NAACOS’s leaders said that “NAACOS congratulates President-elect Biden and Vice President-elect Harris on their victory in the 2020 presidential election and looks forward to working with the incoming administration to promote our transition to value-based healthcare. Even though immediate attention will and should go toward the pandemic, we urge the new administration to prioritize healthcare payment and delivery system reform in its work. In fact, we know from experience this year that population-focused systems are better positioned to handle prevention, treatment and long-term follow-up care for both COVID-infected patients and traditional patients with chronic conditions.”
Further, NAACOS’s leaders stated, “For starters, a Biden-Harris administration should look to promote growth in ACO programs, which have proven to lower the rate of Medicare spending growth, by opening the Medicare Shared Savings Program to new ACOs interested in starting in 2021. A new administration needs to examine unintended and negative consequences of the Centers for Medicare & Medicaid Service’s (CMS) Pathway to Success policies and consider remedies such as restoring lowered shared savings rates for ACOs and allowing providers more time before taking on financial risk. The CMS Innovation Center can promote accountable care models, such as Direct Contracting, by applying lessons we have learned over the last decade.”
NAACOS’s leaders conceded that it appeared that the U.S. Congress that opens in January 2021 will be politically divided, and urged members of Congress and the incoming administration to “look for areas of bipartisan agreement,” adding that “advancing value-based healthcare is one area ripe for attention.”
Indeed, over the last several months, a “battle of the narratives” has developed between senior officials at CMS, especially CMS Administrator Seema Verma, and the leaders of NAACOS, who have been locked in an ongoing war of words over how each side views the federal ACO ecosystem. As noted in its above statement, NAACOS believes that ACOs shouldn’t be as aggressively pushed into two-sided risk models as CMS has now mandated via its Pathways to Success regulation. CMS has thus far taken the stance that if these ACOs aren’t ready to take on downside risk, they aren’t fit for these models anyway.
Meanwhile, as it relates to telehealth, the American Telemedicine Association (ATA) in its statement pointed out that “telehealth has been and will remain a bipartisan issue,” and that the organization looks forward to working with the federal government to improve policies to expand access to telehealth. “During the past four years, the current administration has made many positive changes to Medicare policy to support telehealth. We are very encouraged that President-elect Biden has been on the record in support of telehealth and its continued expansion, and we look forward to working with his administration and with Congress in 2021,” said Ann Mond Johnson, CEO, the ATA. “As we move on from this election, now is the time for policymakers to act to ensure Americans continue to have access to virtual care when and where they need it, particularly to help solve for health disparities among rural and underserved communities.”
HIMSS policy leaders discuss what’s next
On Nov. 9, senior policy officials at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), a health IT trade group with 80,000 members, discussed with members of the media some of the areas they’re closely observing as a change in administration nears.
Three key areas of Capitol Hill focus, HIMSS executives said, will be monitoring legislation that would: permanently improve telehealth access and usage; potentially end the current federal ban on the funding of a national patient identification strategy; and provide sustained funding for public health data modernization.
On the telehealth front, there are several bills that have been introduced that call for removing geographic restrictions, expanding originating sites where patients could be eligible for telehealth, as well as broadening the scope of which Medicare providers are eligible to provide telehealth and get reimbursed for it. While the federal government has removed many telehealth restrictions during the public health emergency (PHE), it’s still unclear which constraints will go back into place once the PHE ends.
In Section 1834(m) of the Social Security Act, Medicare considers these telehealth services the same as in-person visits and will pay for them at the same rate as regular, in-person visits. The Act also restricts the types of providers who can get paid for telehealth services, although as Gray pointed out, the pandemic has shown that providers such as respiratory therapists, occupational therapists, and speech-language pathologists can reach patients where they are for these services through telehealth. “When the PHE declaration ends, these professionals will no longer be able to utilize telehealth, so [advocating for these flexibilities] to become permanent has been big priority for us,” said Gray.
Regarding patient matching, although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires HHS to develop a unique identifier, subsequent federal appropriations language has prohibited its implementation; since 1999, the federal government has been prohibited from spending public funds on the development of a national patient identifier. However, the 21st Century Cures Act— signed into law in 2016—requires the Government Accountability Office (GAO) to examine steps taken by the federal government and the private sector to reduce matching errors.
Last year, the U.S. House of Representatives passed an amendment that would remove a prohibition on funding for a national patient identification strategy, and now, said Thomas Leary, senior vice president, government relations, at HIMSS, the association is pushing to lift the ban and get the same approval in the Senate, “so we can finally get on with HHS being an active an equal partner with the healthcare community in the development of a national patient identification strategy.”
Leary and David Gray, manager, congressional affairs, at HIMSS, both noted during the press call that removing the ban takes on even more significance now, following the recent development from Pfizer that the drug maker’s vaccine candidate was found to be more than 90 percent effective in preventing COVID-19. “We have seen COVID-19 exacerbate the patient mismatching issue, and as we are working to build out a large-scale immunization program, the success of that will depend on accurately matching patients with their information. Monitoring the long-term disease health outcomes of COVID -19 will hinge on making sure that patients’ records are accurately matched,” said Gray.
Leary importantly added that if there’s a multi-dose requirement for this vaccination, there is a critical need to ensure that healthcare professionals know if a given individual has been vaccinated once already, who still needs to be vaccinated, and where the stockpile is. Gray, meanwhile, attested that removing the ban on the unique patient identifier is the first step in the process toward developing a nationwide patient matching strategy, while pointing out that HIMSS doesn’t necessary support the implementation of a nationwide unique patient identifier—though it is one option on the table. “But removing the ban should kickstart large-scale public-private partnership efforts to figure out the best path forward for reducing patient matching errors and getting us as close to 100 percent patient matching success rate as possible, whether that is one solution, or many—whatever it takes to get there,” he said.
Tied to this effort are the public health infrastructure improvements that HIMSS has supported for the better part of the last two years, as part of the coalition of organizations calling for funding for the Data Modernization Initiative at the Centers for Disease Control and Prevention (CDC), said Leary. “We are looking for sustained funding for that initiative,” he noted. “There was $500 million in the CARES Act, and if we look at all the issues raised in response to COVID-19, $500 million to CDC and state and local public health is a nice round number, and is 10-times the amount that was in last year’s appropriations. But to really move forward, we need to make sure we have sustained funding for that program so that the public health community can use 21st century technology, and have a workforce that can collect and analyze all of that public health data,” Leary stated.
