President Trump said recently about healthcare, "Who knew it was so complicated?" Well, we did! Now everyone is learning. As I write this letter, a new American Health Care Act, or "AHCA," barely passed the House. However, it is apparently going nowhere in the Senate, which intends to create its own separate health care bill. Clearly this is all going to take some time and the Affordable Care Act still remains - at least for now. It is also clear that many people, including people in the same political party, have starkly differing ideas of the scope of any new law.
Nevertheless, on a separate road, the slow but inexorable march towards "value based" care (also sometimes called "population health"), where reimbursement is more heavily weighted to results and not just services rendered, continues unabated. This is a bilateral concept; MACRA was approved by 90% of Congress. As a healthcare lawyer, I find that provider appreciation of the inevitability of value based is not universal. To some extent value based issues are already a way of life at hospitals (e.g., hospital readmission penalties) and for physicians (e.g., EHR and contracts with value based requirements). However, I am continuously surprised when I talk with physicians who seem to have just arrived from another planet, because they do not seem to be aware that we are on the cusp of a value based evolution.
One cannot stand by any more hoping that nothing will happen and that the good old "fee for service" system will ultimately fight off all attempts to change it. Change is upon us, and it's going to keep coming! It's time to prepare.
I hope you enjoy this issue of the Broad and Cassel Newsletter!