You've heard the screaming. This year will be Armageddon or paradise, depending on the view, usually with a recent development offered as nominal evidence. With a new administration, new Congress and eight new governors, change is certain.
Amidst the shouting, however, remember that the last few years already have had incredible change (the Medicare Access and CHIP Reauthorization Act - MACRA, ACA, HIPAA enforcement, and the emergence of population health) and large systems like healthcare can only change so fast. Here are some topics that will have talking heads screaming "hot takes," along with some "whispers" of longer-term trends that every physician and practice should note, and a suggestion or two that should be taken with grains of salt.
Payment Models: As of this writing, the outlook for the ACA was "repeal and replace." Government stakeholders have promised broad health insurance, but nothing appears to be solid.
• The screaming hot take is that 2017 threatens individuals with loss of coverage, lifetime limits, exclusions for pre-existing conditions, and termination of Medicaid expansion. In addition, the new for head of HHS, Tom Price is no friend of many alternative payment methodologies, so expect a "back to the future" of pay-for-procedure.
• The best-guess is that parts of the ACA will be repealed, but that may not occur as soon, or as drastically as many thought. Some fund managers, for example, are betting that changes to ACA will be mostly cosmetic. Enrolled individuals are covered through this cycle and significant changes will require at least a couple years to implement. In addition, one proposed plan (The Patient Freedom Act) would allow states to either keep the ACA or receive per beneficiary grants or tax credits. Private markets (including ACA), however, may face turmoil in 2017 if the personal mandate is dropped or if insurance companies are permitted to sell across state lines, leading to consolidation and a potential "race to the bottom." The greatest risks could fall on rural areas.
In the meantime, MACRA is in the books with bipartisan support. Expect a slowing of payment innovations and large, mandatory pilots, but the momentum behind population health will be hard to slow.
• One person's idea of what to do in 2017: Monitor changes as they occur and lock in any advantageous reimbursement rates that may be available. Don't forget to document and report under MACRA to protect revenues in later years.
Healthcare Market Reactions
Healthcare stocks dropped swiftly with the election and, compared to the rest of the market, have underperformed since.
• The hot take: Take your pick: (i) the new administration will favor domestic corporations, punish multinationals, and lower tax rates, which will free up capital for investment; or (ii) protectionism will kill exports and throw the economy into decline.
• The best-guess reality is that any uncertainty around the shape of change will work itself out during the year. In addition, health IT and other vendors may continue to expand, particularly with fewer regulatory concerns. Management companies and institutions may be tempted to roll up physician groups, but reductions in federal regulations could be replaced by state regulations (corporate practice of medicine, CON, etc.), limiting activity.
• One person's idea on what to do: perhaps little to nothing, at least in the first quarter. Trying to guess the direction of a market in a time of change is a sucker's game, but consider any solid opportunities with a long-term strategy.
Health IT and Privacy and Security: A growing and important area will be healthcare IT and HIPAA.
• The hot takes (to ignore): HIPAA regulations (and enforcement) are so 2016. China will hack us all into oblivion.
• Best-guess reality: Growing enforcement of HIPAA will be hard to slow down because privacy and security are popular and enforcement brings money into the coffers. In the meantime, IT development will continue its exponential growth. The hot take here is that 2017 will be memorable for significant development of revolutionary technology that helps at least one of the following: (i) data security; (ii) access and sharing of information; or (iii) connecting wearables and in-home devices to an EHR. Expect momentum for HIPAA-type regulation of wearables and internet-connected devices. Finally, don't be surprised if someone is injured by a hacked medical device, which leads to heightened awareness and security standards in this area.
• What's a person to do? Make sure your HIPAA compliance program is robust, including annual risk assessments. Keep a long view on whether to purchase that new EHR system until you understand MACRA's requirements and where technology is headed.
And, finally, a few other areas where items are likely to hit the news:
• Women's health: Expect the deep divide among States to grow, with rural areas most impacted.
• Opioid abuse and other areas of high public awareness will continue to receive legislative attention.
• Telehealth will continue to expand. Reimbursement of distance behavioral health will continue, with other specialties becoming more common. This is one of the few items that may actually help rural areas.
Whether you are particularly optimistic or pessimistic, 2017 will be memorable. It already is. If we all remember that we are in it together, we can work together and thrive.
Roy Wyman is a partner of Nelson Mullins Riley & Scarborough LLP in Nashville and is a member of the Healthcare Regulatory and Transactional team. He can be reached at [email protected] or (615) 664-5362.