AHA Congratulates Trump, Proffers Wish List

The American Hospital Association urges the President-elect to avoid 'abrupt changes' to the ACA, to cancel Stage 3 of Meaningful Use, to standardize the M&A merger review process, and to reform the RAC program.

The American Hospital Association this week urged President-elect Donald Trump to avoid "abrupt changes" to the Affordable Care Act that could destabilize the healthcare sector.

The plea from AHA President and CEO Rick Pollack came near the end of a four-page wish list the hospital lobby sent this week to the president-elect, who has vowed to repeal Obamacare on his first day in office.

"Given that healthcare represents a significant portion of the economy and essential public services, we urge you not to make any abrupt changes that could lead to significant instability for patients, providers, insurers and others," Pollack told the president-elect.

"Currently, there is much uncertainty about the future, given discussions of repealing and replacing the ACA," he said. "We urge you to ensure that any repeal of portions of the ACA simultaneously include a replacement plan that continues to provide a mechanism for individuals to obtain affordable insurance coverage. In addition, providers' payments were reduced significantly to fund coverage expansion, and also should be reexamined as we debate the future of the ACA."

5 Things Hospital CEOs Want from Trump

Pollack's letter highlighted five areas of concern for hospitals; reducing the regulatory burden; enhancing affordability and value; continuing to promote quality and patient safety; ensuring access to care and coverage; and continuing to advance healthcare system transformation and innovation.

"The regulatory burden faced by hospitals is substantial and unsustainable. We urge your Administration to modify or eliminate duplicative, excessive, antiquated and contradictory provider regulations," Pollack said. "Reducing the administrative complexity of healthcare would save billions of dollars annually and would allow providers to spend more time on patients, not paperwork."

The AHA wants the Trump administration to:

• Cancel Stage 3 of the meaningful use program so that hospitals will not be forced to spend large sums of money upgrading their electronic health records solely for the purpose of meeting regulatory requirements;
   
• Revise the Recovery Auditor Contractor contracts to incorporate a financial penalty for high rates of incorrect denials that lead to unnecessary appeals;
   
• Create safe harbors and waivers under the Anti-kickback statute to protect clinical integration arrangements and revise the "Stark law" to protect arrangements that meet the Anti-kickback safe harbor so that physicians and hospitals can work together to improve care;
   
• Standardize the federal merger review process between the Federal Trade Commission and the Department of Justice to better support hospital transformation;
   
• Eliminate outdated regulations that threaten access to post-acute care, such as the long-term care hospital "25% Rule" and the onerous home health agency pre-claim review demonstration project.

To enhance affordability and value, Pollack urged the new administration to:

• Adopt comprehensive solutions to address escalating drug prices, including providing support for the introduction of generic alternatives, discouraging anti-competitive tactics such as "pay-for-delay" and "evergreening," improving access through drug re-importation, providing mandatory rebates and placing requirements around direct-to-consumer advertising;
   
• Protect the 340B Drug Pricing Program;
   
• Continue to challenge the major health insurance company mergers and other anticompetitive conduct to prevent harmful repercussions for consumers and providers;
   
• Explore policies to help rein in medical liability, such as instituting a cap on non-economic damages and allowing courts to limit lawyers' contingency fees;
   
• Explore Medicare structural reforms to make the program more sustainable while maintaining access to care, ensuring adequate payment for care, and protecting individuals from excessive financial burden, such as combining Medicare Parts A and B, limiting Medigap coverage, further means-testing Medicare premiums and raising the Medicare eligibility age.

To promote quality and patient safety, the Trump administration was asked to:

• Streamline, prioritize and simplify quality reporting to identify and focus on meaningful and valid "measures that matter;"
   
• Modify the current readmissions policy to include a sociodemographic adjustment so that providers are not penalized for factors outside of their control;
   
• Suspend the flawed hospital star ratings on the Hospital Compare website, as they are inaccurate and provide misleading information to consumers;
   
• Develop a performance reporting option that allows hospital-aligned physicians to fulfill the Medicare Access and CHIP Reauthorization Act (MACRA) quality reporting requirements based on hospital measures;
   
• Stop federal agency intrusion in private sector accrediting body standards and survey processes;
   
• Advance health IT by supporting the adoption of interoperable EHRs, promoting a more consistent use of IT standards and providing improved testing, certification and transparency about vendor products;
   
• Reject reductions in Medicare funding for graduate medical education to ensure we have the workforce necessary to provide high quality, safe care to patients.

To ensure access to care and health insurance coverage, the AHA called for:

• Continued funding for the Children's Health Insurance Program;
   
• Improved access to mental health services by addressing workforce shortages, increasing funding for behavioral health services, promoting policies that better integrate mental and physical health, and creating parity in coverage;
   
• Removing barriers to mental health treatment, such as amending the Medicaid Institution for Mental Disease exclusion, eliminating the Medicare 190-day lifetime limit on inpatient psychiatric treatment, and providing funding to implement the Comprehensive Addiction and Recovery Act to help stop the opioid crisis in America;
   
• Rejecting "site-neutral" payment cuts, which prevent hospitals from modernizing their facilities to improve the health of patients;
   
• Congress to remove impediments preventing veterans from using the Veterans Choice Program and advocate to make the program permanent.

To advance health system transformation and innovation, the new administration was asked to:

• Preserve and improve upon new payment and delivery models to drive adoption of those that are most effective in raising quality and reducing cost;
   
• Promote the use of telehealth, remote patient monitoring and similar technologies by removing barriers to their use and payment;
   
• Waive the skilled nursing facility three-day stay rule, telehealth restrictions and prospective beneficiary assignment from all ACO models;
   
• Expand the definition of advanced alternative payment models to allow more clinicians who partner with hospitals on new models to achieve payment incentives under MACRA;
   
• Provide new options on care delivery that reward better, more efficient, coordinated care and help ensure access to essential health care services.

View the AHA's letter.