Though still in the process of determining who will run specific aspects of his administration, it's clear President-elect Donald Trump will make healthcare reform a key priority during his presidency. But what does that mean for ACOs?
Former CMS official and current Vice President of Public Payor Health Strategy and Care Coordination at Greenville (S.C.) Health System Valinda Rutledge and Vice President of Healthcare Consulting at Premier Performance Partners Joseph Damore discussed how ACOs have fared thus far and how they might change under Mr. Trump's administration during a panel at Becker's Hospital Review's 5th Annual CEO + CFO Roundtable on Nov. 9 in Chigao.
During the discussion, Ms. Rutledge explained that as a whole, ACOs collectively lost money for CMS in 2016. According to the most recent data available, she says being part of an ACO this year saved hospitals and health systems "about 24 percent to 27 percent, on average."
Ms. Rutledge says that rather than continue to fund a program that maintains a negative return on investments, Mr. Trump will utilize his business perspective to improve the program for the better and to hold the individuals who run those programs accountable.
"The question, I think, going forward is you have someone coming into office that has a businessman's sort of perspective [who] will be carefully looking at programs and the people [that run those programs.] It is speculated that the individuals that he [hires] will have a lot of accountability...his lieutenants [will] have goals, and will be expected to achieve those goals or [they will no longer] hold those jobs," Ms. Rutledge says. "We could possibly see a lot more turnover in federal senior roles than we have seen in the past."
Mr. Damore added that under the new administration, ACOs will have the opportunity to deliver healthcare in way that is fundamentally different from past initiatives. He recommended hospitals and health systems appoint physician leaders to implement long-lasting change in care delivery.
"[Health organizations' should make it a] priority to develop physician leaders. If you're going to change clinical practice, there's no way that an administrator can change clinical practice…Physicians are perceived as the captain of the ship...so you must have physician leaders in place who really are passionate about [instituting change,] who are able to articulate it and who are able to help share that knowledge with other physicians," says Mr. Damore.
Mr. Damore and Ms. Rutledge also speculated on how the new administration could change the industry. Here are four ways Mr. Trump's administration may alter the way in which healthcare operates in the U.S.
1. Privatization of care. Mr. Damore speculates that the Trump administration will utilize government funds to "jump start" Medicare Advantage programs and will continue to support Medicare Part D. He also believes that the administration will continue to support consumer-driven health plans.
2. Decentralization of healthcare policy. Ms. Rutledge and Mr. Damore agree that the federal government will spend less on Medicare, leaving the responsibility of funding the program to states. They also claim that there will be a move to block grants and that the administration will increase the amount of per capita payments to individual states so that they may be able to create their own healthcare policies.
3. Liability/tort reform. Mr. Damore says that with Mr. Trump at the helm, the federal government will conduct a massive effort to increase tort reform. A tort consists of a wrongful act of the infringement of a right, other than under contract, leading to civil legal liability.
4. Repeal portions of the ACA. Mr. Trump has vowed to repeal and replace the ACA with legislation that enables insurers to sell products across state lines, make health savings accounts part of an individual's estate and require provicers to offer price estimation tools.