Hospital Association Lists Agenda for Trump, Including Retaining Patient Access to Care

The American Hospital Association (AHA) last week issued a pair of letters to President-elect Donald J. Trump, spelling out its policy agenda and calling on the new administration to lighten the regulatory load imposed in his predecessor’s final year.

But the AHA made clear that it wants to keep parts of President Barack Obama’s signature law—the Affordable Care Act—which has extended coverage to 20 million people and, in the process, bolstered the finances of many hospitals.

The first letter, dated November 30, 2016, outlined the AHA policy agenda, including regulatory reform, while the second, dated December 2, 2016, suggested 33 specific steps that the group said would “reduce the burdens on hospitals and the patients they serve.” Both letters were signed by AHA President and CEO Richard J. Pollack.

The second letter took particular aim at CMS’ final year of activity, which the hospital leaders say has produced 43 proposed and final rules “comprising almost 21,000 pages of text,” which the group claims “is beginning to outstrip the field’s ability to absorb them.”

AHA has previously expressed concern about how quickly CMS is pursuing new bundled payment models, as well as updating new reimbursement methods for things like hip and knee replacements while hospitals are still absorbing the initial wave of change.

Highlights of the AHA policy agenda are:

• Reducing regulatory burdens. AHA’s specific requests include relief from stage 3 of the meaningful use program to avoid more spending on electronic health records, fines for contractors with high rates of incorrect claim denials, and an end to what it called “outdated” regulations on post-acute care. Of note, the hospitals argue here for clarity to smooth their own mergers, but elsewhere in the letter they argue against large health insurer mergers.
• Boosting “affordability and value.” Here, hospitals ask the new administration to take aim at high drug prices but keep the 340B program, to “rein in” medical liability, and to seek structural reforms for Medicare, such as further means-testing premiums and raising the eligibility age.
• Promoting quality and safety. Hospitals seek relief from what they say are too many overlapping, burdensome quality reporting requirements, as well as time to ensure adequate information technology and staffing to implement them. Hospitals also want sociodemographic adjustments for readmission ratings, to suspend the “flawed” star ratings on the Hospital Compare website, and to restore funding for graduate medical education.
• Ensure access to care, coverage. Hospitals seek to continue the Children’s Health Insurance Program (CHIP), which has been in the crosshairs of the HHS Secretary nominee, US Representative Tom Price, R-Georgia. They also make a series of requests to improve access to mental health care, and make requests that would make it easier to care for veterans.
• Health system transformation. Hospitals don’t want to lose momentum for payment reform they have gained through accountable care organizations. They also seek an end to barriers on telehealth and better definitions of alternative payment models under the Medicare Access and CHIP Reauthorization Act.

Besides the rules spelled out in its policy letter, the December 2, 2016, letter relists these and other rules that AHA would like to delay or suspend, including:

• The proposed mandatory Part B drug demonstration
• A demonstration program for home health agency pre-claim review
• A rule on third-party payments that AHA says will limit some hospitals’ access to disproportionate share payments

The AHA letter states that despite its flaws, the health reform law extended coverage to millions and withdrawing that coverage would return these Americans to the uncertainty seen before it passed. Hospitals, among other providers, are eager to know what r would replace the Medicaid dollars or tax subsidies that funded coverage for these patients.

“We urge 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,” Pollack’s first letter stated.