Trump presidency may lead to health care reform, changes in orthopedics
Despite plans to reform the ACA, the Trump administration has not mentioned plans for MACRA or CJR.
In the beginning of the presidential debates, President-elect Donald J. Trump said he planned to repeal the Affordable Care Act. However, the weeks following the presidential election saw a slight change in his plans for health care reform.
While Trump plans to maintain some policies of the Affordable Care Act (ACA), such as continuing coverage for pre-existing conditions and the ability for children to remain on their parents’ health insurance until the age of 26 years, Louis F. McIntyre, MD, director of orthopedic strategies for Northwell Health Westchester, noted most of the policies will be up for discussion. The Trump administration has discussed eliminating the 2.3% device tax which, according to McIntyre, would specifically help the field of orthopedics.
“Because it is 2.3% on gross, it is a huge tax. So it will allow [device companies] to have more funds available for research and development, for support and sales forces [and] it will allow start-up companies to be more flexible in regard to how they manage their cash flow and capital,” McIntyre, who is also an Orthopedics Today Editorial Board member, said. “It would be a huge benefit to that sector of the economy.”
Jack M. Bert, MD, of Minnesota Bone and Joint Specialists LTD and Business of Orthopedics Section Editor for Orthopedics Today, noted Trump has mentioned imposing continuous coverage protections, providing state innovation grants and implementing medical liability reform, which would help physicians.
McIntyre added the Trump administration has mentioned placing provisions that will allow for the sale of insurance across state lines.
“They still want to nationalize the health care insurance market, but they’d rather want to make it flexible and not a one-size-fits-all type of vehicle, which is what the ACA does,” McIntyre said. “Trump also wants to do away with the coverage mandates in the ACA, which will make insurance much more affordable and flexible. Health savings accounts are high on his list of policy changes to make health care more patient-centered.”
Although the ACA most likely will undergo changes, there has been no mention of the Comprehensive Care for Joint Replacement (CJR) or the Medicare Access and CHIP Reauthorization Act (MACRA), according to McIntyre. However, McIntyre noted several members of Congress and the American Academy of Orthopaedic Surgeons (AAOS) have begun writing to CMS to “relax some of the more stringent restrictions and mandates inside of CJR and MACRA.”
McIntyre added that one of the most vocal members, Rep. Tom Price of Georgia, was just selected as Secretary of Health and Human Services, which bodes well for meaningful patient and physician friendly changes in rules for these programs.
“The AAOS has laid out several proposals which would, for example, make the CJR voluntary not mandatory; which would stipulate for physician leadership, not just hospitals leadership; and would allow for a separation of the hip fracture bundle to be taken out of the total joint bundle,” McIntyre said.
FDA policies, regulations and drug-approval processes will also need to be modernized to ensure the continuation of health care innovation, Stephen J. Ubl, president and chief executive officer of Pharmaceutical Research and Manufacturers of America, told Healio.com.
“We are in a new era of medicine, with treatments and cures that are completely transforming the fight against debilitating diseases,” Ubl said. “To ensure this innovation continues, we need to modernize the U.S. Food and Drug Administration to keep pace with scientific advances; remove regulatory barriers that make it harder to move to a value-driven health care system; and focus on making better use of the medicines we have today. In addition, we strive to empower consumers with information to make more informed health care decisions.”
Despite the unknown, Thomas C. Barber, MD, chair of the AAOS Council on Advocacy, said there will be many opportunities to address the issues facing orthopedists.
“In the next administration, there should be many opportunities to address some of our priority issues, including repealing the ban on physician-owned hospitals; abolishing the Independent Payment Advisory Board; and reversing the mandatory nature of payment models that have been implemented by the Centers for Medicare & Medicaid Services,” Barber told Orthopedics Today. “We will continue work on protecting in-office ancillary services and advocating for medical liability reform. There will also be a lot of work needed to ensure new payment programs implemented under MACRA are developed and administered in a way that protects the patient-physician relationship.”
HHS secretary nomination
On Nov. 29, 2016, Trump nominated Congressman Tom Price, MD, (R-Ga.) as secretary of the HHS. Price, who worked as an orthopedic surgeon in private practice for nearly 20 years before becoming a politician, introduced the Empowering Patients First Act (H.R. 2300) earlier this year. The bill would fully repeal the Affordable Care Act and focus on the “principles of affordability, accessibility, quality, innovation, choices and responsiveness,” Price said in a press release.
“It is an honor to be nominated to serve our nation as secretary of Health and Human Services,” He said in the release. “Thanks to President-elect Donald Trump and Vice President-elect Mike Pence for their confidence. I am humbled by the incredible challenges that lay ahead and enthusiastic for the opportunity to be a part of solving them on behalf of the American people. There is much work to be done to ensure we have a health care system that works for patients, families and doctors; that leads the world in the cure and prevention of illness; and that is based on sensible rules to protect the well-being of the country while embracing its innovative spirit.”
In a statement, Gerald R. Williams Jr., MD, president of the AAOS, noted Price has worked closely with the AAOS “on issues including repeal of the Medicare sustainable growth rate formula, oversight of mandatory bundled payment models, increasing flexibility within electronic health record programs, defending important in-office ancillary services and protecting the patient-physician relationship.”
“He has been an indispensable voice within the House Republican Doctors Caucus, making significant contributions to health policy reform and furthering the interests of patients,” Williams continued. “And he has been one of the most important champions in improving the care of patients in the specialty, rural and small or solo practice settings.” – by Casey Tingle
AAOS statement on nomination of orthopaedic surgeon Tom Price. Available at: http://newsroom.aaos.org/media-resources/Press-releases/aaos-statement-on-nomination-of-orthopaedic-surgeon-tom-price.htm Accessed Nov. 29, 2016.
For more information:
Thomas C. Barber, MD, can be reached at 280 West MacArthur Blvd., 1st Fl., Oakland, CA 94563; email: email@example.com.
Jack M. Bert, MD, can be reached at Minnesota Bone & Joint Specialists, 17 W. Exchange St., Ste 110, St. Paul, MN 55102; email: firstname.lastname@example.org.
Louis F. McIntyre, MD, can be reached at Northwell Health, 755 N. Broadway #530, Sleepy Hollow, NY 10591; email: email@example.com.
Stephen J. Ubl can be reached at Pharmaceutical Research and Manufacturers of America, 950 F St., NW Suite 300, Washington, DC, 20004; email: firstname.lastname@example.org.
Disclosures: Ubl reports he is employed by Pharmaceutical Research and Manufacturers of America. Barber, Bert and McIntyre report no relevant financial disclosures.