Healthcare Technology Featured Article

November 23, 2016

Reading the Tea Leaves: What Lies Ahead for Health IT in the Trump Administration?

The voters have spoken and there will be a new administration in less than two months. What does this mean for health information technology (health IT)? Looking at the tea leaves, here’s my preliminary take on the short-term impacts.

At the federal level:

 Legislation. There are three laws that could be impacted by the change in administration.

  • Affordable Care Act (ACA). President-elect Donald Trump was vocal about wanting to repeal and replace parts of this law during his campaign. He’s highly likely to make good on this promise. Early reports indicate this could happen quickly. Making modifications to ACA is likely to occupy a lot of time and energy by the Congress and his administration this coming spring. Replacement legislation could have cascading effects on health IT, such as requiring changes to the healthcare infrastructure emphasizing interoperability, connectivity and information exchange. Moving millions of patients off and on various public and private insurance plans also creates demand for health IT and a new patient identifier. It also is possible that the Center for Medicare and Medicaid Innovation will be in the crosshairs. If it survives, it may no longer be an agent of change.
  • Medicare and CHIP Reauthorization Act (MACRA). The new administration will continue implementation of the health IT provisions contained in the Merit-Based Incentive Payment System (MIPS), which is one of two Medicare payment tracks authorized under MACRA. The health IT part of MIPS accounts for a quarter of physicians’ scores for Medicare payments under this track. Details were spelled out in a recent final rule that likely will not be revisited in the near future. However, President-elect Trump has promised to reduce government regulations, and this new rule is long and complicated. It is possible that once stakeholders have had a chance to digest this regulation and size up the new administration, there could be movement for something different down the line.
  • 21st Century Cures Act. Stakeholders should not overlook this bipartisan legislation, which has been a work in progress for more than a year (not to mention 19 separate amendments in the Senate). Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan recently announced that final touches were being made to the legislation and they expect to have it on President Barack Obama’s desk by the end of the year. He presumably will sign it because it’s a bipartisan effort and seemingly has “motherhood and apple pie” provisions (although advocates have concerns about some of them). If signed, the Trump Administration will have to implement it.

Most people are familiar with this proposed law because it would provide additional funding to the National Institutes of Health and streamline requirements for drug approval by the Food and Drug Administration. Of interest to health IT junkies is Section 3001, Interoperability. According to a summary, these provisions would “refocus national efforts on making systems interoperable and holding individuals responsible for blocking or otherwise inhibiting the flow of patient information throughout our health care system.” How these provisions would mesh with efforts under way by the Office of the National Coordinator for Health IT (ONC) concerning information blocking have yet to be determined.

  • Appointments. President-elect Trump did not say much about health IT during his campaign, but we know that as a chief executive officer he will want to surround himself with top-notch people. As a result, there are several key appointments that could impact health IT.

The first is secretary of the Department of Health and Human Services (HHS). Several candidates are rumored to be under consideration. We don’t know their experience or level of interest in health IT. However, because of HHS’ regulation of health IT and its use in research, quality and payment, the secretary will be involved. The incoming secretary will also need to rely heavily on the new administrator of the Centers for Medicare and Medicaid Services (CMS) and the head of the ONC. This is where the rubber hits the road when it comes to health IT. CMS will continue its work on standards for Medicare Part D and implementing MIPS’ health IT provisions. Insiders expect the ONC to continue its certification of health IT as required under MIPS. It also is likely to remain the focal point of interoperability, including addressing information blocking, as expressed in a recent report to Congress. That said, it is unclear whether this issue will be of interest to the Trump administration.

Health IT stakeholders also should not overlook the head of the Centers for Disease Control and Prevention (CDC). Don’t forget that the CDC has been involved in health IT, including monitoring progress toward adoption of electronic health records and issuing a 10-year interoperability plan. Will the agency continue to have a say in health IT in the Trump Administration or will it return to its traditional focus on health promotion and disease prevention? 

Two transition advisors could have some very influential thoughts as to who might fill these HHS jobs and what their portfolios might be. The first is Newt Gingrich, who is heavily involved in advising the transition team. Gingrich knows quite a bit about health IT. He was heavily involved in health IT circa 2005; his organization, the Center for Health Transformation, authored the book Paper Kills, which was among the first publications to promote the need for and benefits of health IT. The second is Mike Leavitt, former governor of Utah who then served as HHS secretary from 2005 to 2009. In the latter capacity, he oversaw a considerable number of groundbreaking efforts and policies related to health IT, including those related to electronic prescribing under Medicare Part D.     

Another potential appointment of interest, although in the longer term, is head of the Veterans Administration (VA). If the VA privatizes some facets of veterans’ care, there will be new and considerable demand for health IT infrastructure and connectivity — as well as the need for a national patient identifier and work on more accurately enabling health IT to connect patients to their records across the health care system. 

  • Payment systems. The move toward value-based care is necessary to reduce costs and improve quality. Will the new administration continue the government’s role in promoting value-based reimbursement as well as sponsor demonstration programs and pilots for affordable care organizations and patient-centered medical homes, for example? Or will that that be left to the private sector? If so, it could be some time before the private payers step in. President-elect Trump might be interested in the issue as a businessman, a purchaser of health insurance for his company and a proponent of the free market system.

Telehealth: President-elect Trump’s plan for VA reform called for use of telehealth, in the form of satellite-based clinics, for veterans in rural and underserved areas. Given that this emerging technology is expected to cut costs and improve care delivery, adoption by the VA could bode well for expanded use of telehealth by public and private payers.

  • Fighting the drug epidemic. The Trump Administration will be facing the epidemic of opioid abuse and heroin overdoses, which have shown no signs of abating. States are expected to continue enacting legislation requiring use of electronic prescribing of controlled substances (EPCS) and prescription drug monitoring programs (PDMPs). It is possible the ONC will be asked to step up its role in promoting PDMP interoperability and EPCS.

At the industry level, several things could happen in relation to health IT. For example:

  • Short-term Inertia. Not surprisingly, some segments of the industry will shift into neutral until the dust settles on what the Trump Administration will require in the way of health IT and how it will be implemented. Electronic health record (EHRs) and revenue cycle management (RCM) companies will likely slow development as well as put certain agendas on hold, such as population health.
  • Revisit budgeting. Payers, facilities and other health care entities will likely be revisiting management of their revenue cycles and costs in light of the change in administration. It’s very possible that many will go into freeze mode in terms of capital and nondiscretionary spending for several months, if not all of 2017, because of uncertainty and the need to review and revise strategies. This will have a ripple effect on acquisition and replacement of health IT and related infrastructure.
  • Slowdown in mergers and acquisitions (M&A). Until the election, the health IT market had begun to consolidate. Now that there’s a new administration, consolidation is likely to ratchet down, if not come to a screeching halt, until a clearer picture emerges as to where things will be going. In addition, health systems, which have been investing a lot of money in value-based care and the acquisition of hospitals, will likely pull back on M&A. As a result, they will put off investments in health IT and infrastructure systemwide or fold new acquisitions into what they already have.

All in all, health IT will continue to be an integral part of the solution, not part of the problem (although admittedly there are, well, opportunities for improvement). The keys will be actors, agents and timing.  

Edited by Alicia Young
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