Health care discussions (other than ACA and AHCA) in Washington

Thursday, April 13, 2017 | Larry Sobal

 

Last week I was in Washington DC along with the physician and administrative leaders of the Cardiology Advocacy Alliance (CAA) Board of Directors. We were there to meet with members of Congress, the Senate and the White House on a number of issues facing cardiologists and heart programs.

Our two days of meetings involved both Republicans and Democrats including those elected officials and/or health advisory staff in key positions within the White House, Senate Finance, House Ways and Means, Energy and Commerce, and GOP Doctors Caucus. In other words, we met with those who are/will have substantial influence on health policy, particularly Medicare, today and going forward.

Our focus was to learn where elected officials stand on key advocacy areas, educate them on the realities facing the hundreds of heart programs and thousands of cardiologists we advocate for, and offer our recommendations on what actions should be taken to improve upon existing legislation and federal policy.

Our six key priorities were:

1. The toll of Administrative Burdens on physicians
2. Outdated Fraud and Abuse laws (i.e. Stark) that are now barriers to necessary collaboration
3. Pros and Cons of various Alternative Payment Models (APMs), MACRA, etc.
4. Unrealistic expectations related to Advancing Care Information (formerly Meaningful Use)
5. Real-world implications from the lack of EHR Interoperability
6. Lack of industry readiness to implement Appropriate Use Criteria (AUC)

Note that no part of our visit was intended to weigh in on the Affordable Care Act or the American Health Care Act (AHCA), although the President had just called off the AHCA vote a few days before our visit and there were still active conversations taking place. Not surprisingly, many legislators offered their perspective to us during the conversation. I found the fresh (sometimes raw) and candid viewpoints offered by virtually every elected official we met with extremely beneficial to better understand this complex (and complicated) subject. But I digress.

I was very encouraged by the depth of understanding of our priority areas and/or the sincere willingness to listen to our points of view. Although I am as frustrated as anyone with the current Republican vs. Democratic stalemate and lack of bipartisan thinking, I left with a greater appreciation of our elected officials, their dedication, and a deeper understanding of the complexities of government and public policy. Just as health care is complicated (who knew?), so is Washington politics.

Furthermore, I appreciated that we enjoyed great attentiveness and dialogue, with a few legislators extending our meetings well beyond their allotted time through a sincere intent to hear our “view from the trenches” perspective on how health policy impacts daily patient care, often in unintended ways. It reminded me that it’s easy to criticize politicians, and that many of us don’t have much understanding of how the political process works (or doesn’t). For the most part, people who go to Washington do so with good intentions. Again, I digress.

Our conversations during this visit tended to focus on three major themes.

First was the request to slow down the pace of disjointed health policy implementations so that physicians, hospitals and IT vendors can “catch up.” We emphasized that a significant amount of change—MACRA, Bundled Payments, Site Neutrality, ACOs, AUC, Meaningful Use, etc.—has been implemented recently in health care, which collectively has placed a great strain on providers (physicians and hospitals) and has often gotten in the way of what is most important—providing patient care.

We enjoyed great attentiveness and dialogue . . . and a sincere intent to hear our “view from the trenches” perspective on how health policy impacts daily patient care.

We shared examples of how, as each new federal program is implemented, a whole host of administrative changes and processes are required that reduce time physicians can spend with patients (as they now spend more and more time with reporting and administrative tasks), and can adversely impact patient satisfaction and quality of care.

We tried to emphasize how these new programs often fail to account for the cost of implementation, which can be significant in lost productivity, additional overhead and further capital investment in Information Technology. It’s fair to say that many of these elected officials were unaware of the amount of time that physicians now must spend on non-clinical duties brought on by these resulting administrative burdens, nor were they fully aware of how little progress has been made in regards to EHR interoperability.

Second, we were able to have robust conversations around the need to “modernize” Fraud and Abuse (i.e. Stark and Anti-Kickback) laws so that they are no longer standing in the way of collaboration and alignment between the various physicians, hospitals and other health care providers along the care continuum. I was very encouraged by the recognition that the current Fraud and Abuse legislation was developed for an era much different than today. We were able to offer some excellent examples of how, as we move toward a fee-for-value environment, many of the aspects of these laws are outdated, and hinder programs that move us to the Quadruple Aim. Furthermore, we pointed out that the various Fraud and Abuse waivers granted under some programs are inadequate, and highlighted the need to revise the definition of “group practice” by removing the “volume or value” standard.

Third, we talked a lot about unintended consequences despite good intentions. One example is the good intent of letting physicians pick their pace of MACRA in 2017, and the potential unintended consequences of the decision to publically report 2017 submitted data that could reflect negatively against physicians who choose to opt for the minimal reporting option, and the danger that less-than-perfect patient attribution methodology brings to publically reported data.

Space does not allow me to share all of the details of what we learned, discussed, and recommended. However, I can share that there were a number of legislators who agreed to advance our viewpoints to other colleagues, and some key officials asked that we prepare a letter outlining our key recommendations that they could share with colleagues before forwarding to HHS Secretary Price. We also received an invitation to come back and meet with the full Doctors Caucus.

While I’m not ready to proclaim Washington a bipartisan, bureaucracy-lacking governmental machine, I was very encouraged by our visit and the level of engagement we experienced. And perhaps more than ever before, I can say with conviction that everyone in health care should get involved in advocacy efforts at some level—either by attending a Fly In, hosting an elected representative at your organization, or simply writing your elected officials and sharing your point of view. Democracy is a participatory team sport, so don’t sit in the stands and complain if you aren’t prepared to get in the game in some way. Your voice only matters if you use it to express your views, the rationale behind them and offer constructive recommendations.

 

Illustration: Lee Sauer

---

 

Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.

.

---