Many organizations have asked me to comment on the impact of the Trump presidency on health care and health care IT. I served the Bush administration for four years and the Obama administration for six years. I know that change in Washington happens incrementally. There is always an evolution, not a revolution, regardless of speechmaking hyperbole.
What am I doing in Massachusetts? I’m staying the course, continuing my focus on social networking for healthcare, mobile, care management analytics, cloud, and security while leaving the strategic plan/budget as is.
I have no inside information and no involvement with the Trump campaign/transition team. From talking to people in Washington and reading publicly available resources, I believe there are 10 themes that will guide us over the next two years.
1. It’s likely that some corporate and personal taxes will be reduced, possibly increasing the funds available for innovation.
2. It’s likely that some regulations will be eliminated/simplified, possibly creating more free time/attention span for innovation.
3. It’s likely that free market competition will increase and some of the political infighting around issues such as Medicare’s inability to negotiate drug prices may dissipate.
4. As corporate taxes are restructured, we may see repatriation of funds currently sequestered offshore. The tax cost of bringing such funds back to the U.S. today is 40 percent. It may be 10 percent in the near future.
5. Although much has been said about replacing the Affordable Care Act, it’s likely that it will simply be amended to reduce the focus on health insurance exchanges. There will be no public option for health coverage. Private payers will be encouraged to offer products across state lines. Pre-existing conditions will still be covered. Children will be covered on their parents health plans until age 26.
6. Medicaid will be moved closer to the states. States will have more funds to invest in innovation. Since states will directly benefit from cost savings resulting from investments in innovation incentives will be aligned.
7. FDA scrutiny of new products may be streamlined.
8. FTC enforcement actions may be relaxed.
9. NIH funding may be cut, and projects like the cancer moonshot, precision medicine, and the Center for Medicare and Medicaid Innovation may be scaled back.
10. Most importantly, the transition from fee for service to value-based purchasing will continue unmodified. This means that all the work we’re doing to improve quality, safety, efficiency, patient/family engagement, and population health will still be high priorities.
I recently spoke with administrators in Washington, and they reminded me that although political appointees all resign on January 20th, career appointees will continue doing the work already in progress. Regulation can be changed in the medium term, but legislative changes (even with a Republican House and Senate) takes a long time. MACRA/MIPS is legislation. The Quality Payment Program is regulation implementing MACRA/MIPS. The career employees are on track to implement the Quality Payment Program as scheduled: 2017 to 2019.
My advice is to remain agile, keep calm, and assume that many Obama-era health care IT programs will persist. Focus on reducing total medical expense, measuring quality across the community, providing stakeholders with tools that are valuable to them, spreading the burden of data capture among teams of caregivers, and enhancing interoperability.
Working together and staying focused, above the fray of politics, we can make a difference.
John Halamka is chief information officer, Beth Israel Deaconess Medical Center, Boston, MA, and blogs at Life as a Healthcare CIO.
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