Trumping Obamacare not likely to affect MACRA/MIPSNovember 17th, 2016 by
It’s the Friday after the election; at the NY Medical Director’s conference this morning, Physicians were asking if the President-elect’s promise to repeal Obamacare will affect their practices.
Predicting what’s going to happen under the Trump Administration is a fool’s errand. However, it is apparent the focus of the Republican Congress over the past 6 years has been aimed toward repealing the mandates for individual insurance, the federal financing of Medicaid Expansion, and the provisions for State and Federal insurance pools, and under Trump’s administration, they may now have the ability to do so.
True, the PPACA also launched a series of sweeping Medicare reforms, but those were all aimed at reducing the spending curve’s rate of increase. That problem isn’t going away as the Baby Boom Generation reaches Medicare eligibility – they have relatively low retirement savings, many chronic problems, and relative longevity. Keeping Medicare solvent, while avoiding angering voters, is a task Congress will probably leave to the CMS – unless there is a politically advantageous legislative alternative.
All of Part B Medicare is now governed by MACRA/MIPS – which passed with broad bipartisan approval, recognizing the inherent flaws with the Sustainable Growth Rate. Some elements of the Medical Community may want parts of MACRA/MIPS rolled back, but to what? Privatizing Medicare may appeal to those with libertarian leaning, but I doubt that will play well with many of the electorate.
Part A Medicare is already moving rapidly to Bundled Payment strategies for most hospital episodes – which hurts hospitals but seems to be a strategy that hasn’t raised problems with the voting public.
Some elements of the PPACA, like the Innovation Center, are probable targets, but the reforms that program launched, e.g. ACOs – are likely to remain after being reassigned to another department within CMS.
Trump’s plan, or lack thereof, has been assumed to be modeled by Paul Ryan’s Patient’s Choice Act. Though Trump is a political outsider with no discernible legislative record for the electorate to gauge his decision-making, it is expected that he will pull his knowledge from already established reform proposals from the Republican Party. So, Trump may be the proverbial ‘political wildcard’, but his actions may be more predictable than previously expected.
While it would be comforting if Congress and the new administration would bring a scalpel to the most onerous parts of MACRA/MIPS Regulations, I think that is wishful at best. There’s not much real choice, so start your MIPS planning for 2017, and expect it to be our companion through all of 2018.