Constant State of Evolution


Blog by W. Stephen Love, President/CEO, DFW Hospital Council

As we review the rapidly changing landscape of the healthcare delivery system, four major topics are emerging.

First, the discussion to repeal and replace the Affordable Care Act (ACA). This really involves a series of sprints rather than a marathon. President-Elect Donald Trump could use executive orders to stop the enforcement of the employer mandate. He could also revise medical loss ratios and the Cadillac tax, or perhaps fail to pursue insurance stabilization initiatives.

The Senate will use a process known as reconciliation where 51 votes are needed versus 60, and it must act by January 27. Congress goes on recess February 17, so a bill would need to be on the President’s desk by then with the debt ceiling suspension expiring March 15.

This is concerning because coverage, access, quality and outcomes are crucial. We would hope they could be addressed in any replacement plan. This could have future ramifications because if the ACA is repealed without restructured or replacement elements, expense reductions might immediately occur and then replacements implemented in the future.

The federal scoring budget by the Congressional Budget Office would be required for the replacement, reviewing the 10-year impact of the legislation on the federal deficit. The impact could create a fiscal crisis placing patients and providers at risk for reimbursement.

Second, hospitals agreed to significant reductions to Medicare and Medicaid disproportionate share (DSH) in exchange for coverage expansion. If the ACA is repealed, these reductions should be reinstated. In addition, any changes to Medicaid such as block grants, per capita caps or modifications to waivers need to be thoroughly reviewed and modeled to ensure fair reimbursement.

Third, there are many discussions in Washington about Medicare Modernization which has many moving parts. There is no consensus on future Medicare reform.

Fourth, providers (physicians and hospitals) are inundated with regulations such as Recovery Audit Contractors (RAC). Any healthcare reform should include regulatory relief.

In conclusion, all stakeholders need a seat at the table in this serious discussion on healthcare evolution. Participants should be bipartisan, open-minded and have the most important stakeholder as the top priority – the patient. If so, we will develop a healthcare future with an efficient, cost effective system with quality outcomes and metrics to measure the results of our treatment.

Let’s evolve into a system we all take ownership of and strive for success.