Moving into 2019, political disagreements and legal issues remain in the background —including an ongoing partial federal government shutdown and a court ruling that the entire ACA is unconstitutional.
But Rick Pollack, president and CEO of the American Hospital Association, said he believes there are four areas affecting healthcare with potential for bipartisan agreement. He outlines them below.
1. Drug costs. Hospitals and health systems are exploring ways to reign in rising drug costs, which represent a major portion of their budgets. Hospitals believe there is a need to move forward on legislation to address drug prices in 2019, said Mr. Pollack.
One bipartisan bill that could see motion this year involves drug prices in TV ads, according to The Hill. Rep. Jan Schakowsky, D-Ill., and Sen. Dick Durbin, D-Ill., have introduced legislation in their respective chambers, titled the Drug-Price Transparency in Communications Act. The legislation would require drug price disclosure in TV ads and is similar to an HHS proposal that would require drugmakers to disclose the list price of a drug paid for by Medicare or Medicaid in their TV ads if its monthly cost exceeds $35.
The advertising legislation passed the Senate in 2017 but did not make it through the House. As Democrats take over the House in 2019, Ms. Schakowsky said the advertising bill could see motion, according to The Hill. The publication noted that Sen. Chuck Grassley, R-Iowa, who will lead the Senate Finance Committee moving into 2019, has supported the Senate's version of the bill.
2. Infrastructure bill. An infrastructure bill could also move forward in 2019 as Democrats take control of the House, according to Newsday. In an opinion piece for The Washington Post, Senate Minority Leader Chuck Schumer, D-N.Y., said Democrats agree with President Trump that infrastructure could be an area ripe for compromise. But, the senator said, "if the president wanted to earn Democratic support in the Senate, any infrastructure bill would have to include policies and funding that help transition our country to a clean-energy economy and mitigate the risks the United States already faces from climate change."
Mr. Pollack said if there is an infrastructure bill, the AHA believes parts of the bill could have implications for healthcare.
"Specifically, the AHA supports expanding digital infrastructure and rural broadband, strengthening the capacity and capability for emergency preparedness and response, and assisting hospitals in 'right-sizing' to meet the needs of their communities," he said.
3. Regulatory modernization. The federal government has shown interest in making regulatory changes to outdated systems. In June 2018, CMS sought recommendations from the public on how to reduce the burdens of Stark Law compliance. The 1989 Stark Law, named after former Democratic Rep. Pete Stark, was designed to curb physician self-referral and has evolved into a complex set of regulations. But Mr. Pollack said the law was created under a fee-for-service model and doesn't make sense in today's healthcare environment that is focused on moving to value-based arrangements.
HHS' Office of Inspector General is also looking to change or add safe harbors to the Anti-Kickback Statute, which bans the offering, solicitation or acceptance of remuneration in exchange for referrals for services reimbursed by federal healthcare programs.
"Regulatory relief affects everyone in the [healthcare] field and at top of that list is modernizing Stark Law and other laws … that prevent us from rewarding physicians for improving quality, [giving] bonuses for adhering to clinical standards that may reduce utilization and improve quality, [and] giving people incentive payments that move us toward value-based care," said Mr. Pollack. "That all needs to be cleaned up and the administration has signaled a willingness to move in that direction."
4. Delivery system reform. As healthcare continues to move from fee-for-service to value-based payment mechanisms, hospitals are looking at new approaches to deliver services to meet the healthneeds of the populations they serve.
Mr. Pollack notes this is particularly true in rural areas. For instance, U.S. Reps Lynn Jenkins, R-Kan., Ron Kind, D-Wis., and Terri Sewell, D-Ala., have introduced bipartisan legislation called the Rural Emergency Medical Center Act of 2018. The legislation would establish a new rural facility designation under Medicare allowing certain eligible hospitals to transition to a 24/7 emergency medical center with enhanced reimbursement and transportation to higher acuity facilities, if needed, according to the AHA.
Mr. Pollack said the Rural Emergency Medical Center Act represents a potential opportunity for rural hospitals to reconfigure themselves to better serve their communities because a lot of rural areas face challenges in preserving healthcare access. However, he said it's unclear whether such legislation can pass or whether CMS' innovation center can begin demonstrations in this area.
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