Posted on Monday, November 14, 2016 12:21 AM
Post-Election “Things to Watch” for Home-Based Care Providers
With the unexpected results of the election last week and discussions about key appointments in the news, it is too early to start forecasting potential impacts of a Trump administration and a Republican Congress on home based care providers.
The leaders I’ve been speaking with are unanimously in “wait and see” mode. With a lot of opinions and not a lot of hard facts to look at yet, this is really the best stance for now.
But there are some areas we can begin to examine to start our “guessing” at what might be coming our way in home-based care. And all of us as leaders, as we always do, owe it to the patients in our care, our staff and all of our other stakeholders to closely watch as things start to unfold over the next few months. At the end of this post, I have linked several good articles from sources I regularly read and trust on topics like this.
Here’s my first cut at some areas to be watching:
1. How Campaign Statements Start to Evolve to Policy. There is nothing in existing
Trump policy statements that directly addresses home based care. Several of his priorities, if implemented would have direct and indirect impacts on the industry, depending on how they are realized:
- “Repeal and Replace” ACA. Obamacare has been a major talking point for Trump, but mainly on the issue of health insurance. As ACA has been implemented over the past six years, home based care providers have seen reimbursement changes (mostly negative) and market/business changes (mostly positive), the latter stemming mainly from new reimbursement models that ACA programs such as the CMS Center for Innovation has led. How “repeal and replace” takes shape is the key area to watch. A full repeal could happen, but would leave a lot in limbo while the “replace” could take months or longer to realize. A full repeal would also stop progress on initiatives such as on value based purchasing and bundle payments. A partial repeal could focus on private insurance “fixes” that could leave home based care providers largely unaffected. Some of my links below go into more detail about the questions and possible “how’s” of all this happening.
- Block Grants to Medicaid. Block grants would move a lot of government authority, funding and oversight for health related programs from the Federal to state level. Many home-based care providers are increasingly involved in Medicaid programs (especially for dual eligible) and other community based services. So this area bears watching – as an opportunity (increased home and community based services programs at the state level) and a threat (especially for multi-state home based care providers who will be additionally challenged to understand and work with a much greater variety of programs than they already do).
- Reduced Regulation, Smaller Government, “Business Sense”. Although not specifically addressed in Trump’s healthcare policy statements, these broader themes of his other policy positions will come into play for healthcare. The opportunities for home health and hospice are greatest here – via reduced regulations, and the growing understanding of home based care as a high quality, lower cost alternative to traditional facility-based case. Bundled payment initiatives are also likely to continue, a place where home-based care providers have seen increasing opportunity.
2. How the New Republican President and Republican Congress Get Along
- Campaign Statements vs. the Existing Republican Platform. It is unknown how these directional statements turn into action in the new administration. The Trump campaign and the Republican stances on healthcare are not aligned, so the outcome will depend on reconciliation and negotiation between the new Trump administration and the Republican Congress. One area of probable agreement is ACA “repeal and replace”, but what form this takes is unknown at this time. A great recent post on the Health Affairs website (linked below) walks through the possibilities very thoroughly.
- Transition Team, and Congressional Approval of Nominations. Leaders for the Trump healthcare transition team were announced today – Andrew Bremberg and Paula Stannard. These picks infer an early focus on “repeal and replace”, a reduced Federal government role in healthcare, and continuation of ongoing payment transformation. We’ll start to see key nominations announced in the next few weeks, and while a Republican Senate will be able to largely deliver approvals, there may be some surprises here.
3. Old Friends with New Power. Several issues that matter most right to home-based care providers are not at the level of national policy focus or debate. More so, issues that impact us are matters mainly discussed by members of Congress, CMS and HHS. In at least one way, this is a good thing, as home-based care has solid friends in the Republican Party in both the Senate and the House, ones who have been consistent in their support for improving the government environment for our area of healthcare. Among the issues for which Republicans have been vocal in their support include the reduction and/or delay of the Pre-Claim Review Demonstration.
Here are some additional items for you to look at on this topic – all from sources which can keep you informed during these next few uncertain months:
Health Affairs – “Day One and Beyond: What Trump’s Election Means For The ACA”
The Health Care Blog – “Dancing on the Grave of Obamacare: Questions”
Home Health Care News“Home Health Industry Ponders Meaning of Trump Victory”
Modern Healthcare“Will value-based payment initiatives continue under Trump?”
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