An Appeal to Incoming President Trump

Thursday, November 10, 2016 | Larry Sobal

Dear Mr. Trump,

As a cardiovascular health care executive, I would like to suggest four initiatives be added to your health care agenda upon taking office. These are suggestions for improving the system, and are not related to what you do or don’t do with the Affordable Care Act. In a blog post last month, I mentioned that health care was not a major election topic. Now there is time to make things right for the people who are struggling to provide care in an increasingly complex and inefficient industry.

#1 – CMS needs more legislative oversight

Currently, the Department of Health and Human Services (HHS) is the federal agency that administers CMS along with Medicaid, the Children’s Health Insurance Program (CHIP) and the insurance exchanges (among others). HHS works with almost one-fourth of all federal governmental expenditures and administers more grant dollars than all other federal agencies combined.

CMS has spent tens of billions of dollars to develop and implement programs that test ways to transition health care delivery and financing away from the current fee-for-service payment model to one that is predicated on performance. Some of these have worked while others show very little evidence of improving quality and reducing costs. The opaqueness and unintended consequences of CMS policy decisions requires thorough congressional oversight, something that is inadequate today. A good example of this is covered in suggestion #2.

#2 – Simplify and pace the release of new legislation

In the past month alone, CMS issued 7,348 pages of new legislation covering MACRA, Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, Merit-Based Incentive Payment System and Alternative Payment Model Incentive under the Physician Fee Schedule and Revisions to Payment Policies Under the 2017 Physician Fee Schedule. 

The above page total does not include the pending Final Rule regarding Bundled Payment Models for high-quality, coordinated cardiac and hip fracture care. This legislation can conceivably take the total pages of newly introduced rules to 10,000 or more. At two inches per 500 pages, that would be a 40 inch stack of documents outlining changes that health care organizations need to study, digest and implement, sometimes in just a matter of weeks. Overwhelming an industry with that much change at once is not a recipe for success.

I’m hoping you can be the catalyst for creating the dialogue and unification that gives everyone in America the access and quality of care they deserve, delivered by caregivers who are unburdened from irrational administrative requirements.

One perfect simplification example would be to alter the currently proposed Episodic Payment Models for AMI and CABG. Providers have not had enough experience with these types of models to be ready for implementation on July 1, 2017. It makes more sense to move implementation to January 1, 2018. In addition, since AMI would be the first condition-based EPM, and AMI diagnosis is very complex, this should be simplified to a STEMI only bundled payment episode and create smaller pilots around AMI.

#3 – Embrace the Quadruple Aim

In case you haven’t noticed, we’ve taken some of the most honorable health care professions and slowly squeezed the joy out of them. Caregivers face overwhelming administrative requirements, which are estimated to consume approximately one-sixth of their work hours and directly contribute to diminished satisfaction with providing medical care. Much of the frustration is attributed to EHR technology, which is costly and clunky at best. Furthermore, legislative attempts to impose EHR utilization has not lead to necessary interoperability. 

My advice is a sweeping redesign of the EHR adoption and utilization incentives. First, Meaningful Use has long outlived its usefulness and the decision to reposition Meaningful Use as Advancing Care Information in MACRA is really just Stage 3 in disguise. MACRA should be simplified and improved immediately by getting rid of this component altogether, if you decide to keep MACRA at all, as will be addressed in #4 below.

#4 – Create a Joint Committee on Health Care

You’ve just come through the most contentious and divisive election in our nation’s history. Not only is there a lack of bipartisanship, there is growing disdain for the two-party stalemate.

My advice is to break this standoff, and health care is the logical place to do it. You need to appoint a bipartisan Committee focused on health care. Make sure that this committee has significant inclusion of elected physician representatives. Require the Committee to seek out the advice and involvement of health care leaders—and not those with agendas dominated by something to lose, such as commercial payers, the AHA or AMA.

This transparent committee should be given six months to prioritize issues and bring a consensus proposal forward to the American public. Until then, MACRA should be placed on hold as should all further recently announced CMS initiatives. 

As the next President of the United States, you are inheriting a health care system that is struggling under legislative bureaucracy. I’m hoping you can be the catalyst for creating the dialogue and unification that gives everyone in America the access and quality of care they deserve, delivered by caregivers who are unburdened from irrational administrative requirements. Thanks for listening; I’ll be watching closely to see what you do next.

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

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