The Trump administration issued a 119-page manifesto Nov. 3 detailing more than 50 recommendations to promote choice and competition in the U.S. healthcare system.
Here are seven things to know about the report:
1. It is a product of a working group comprising members of HHS and the Departments of Treasury and Labor. It was created as a response to the Oct. 12, 2017, executive order from President Donald Trump.
2. The report describes how various stakeholders, laws and regulations affect the current state of healthcare competition. The conclusion is that healthcare spending is rising, and the administration believes certain regulations are suffocating choice and competition. Its recommendations to reverse course fall under four general areas.
3. The first area is the healthcare workforce. Several key recommendations to promote competition and choice in this arena include:
- Broadening the scope of practice for practitioners like physician assistants and dental hygienists so they can be paid directly and require less supervision.
- Providing better reimbursement for telehealth.
- Enabling multistate medical licenses, and along with that, flexibility to provide telehealth across state lines.
- Reallocating graduate medical education funding based on which hospitals train the most residents in in-demand specialties.
4. The second area addresses provider markets. Recommendations include:
- Repealing or scaling back state certificate-of-need statutes that limit building new hospitals.
- Reducing restrictions on physician-owned hospitals.
- Allowing the Federal Trade Commission to monitor nonprofit healthcare entities.
5. The third area is insurance markets. Recommendations include:
- Scaling back the ACA's employer insurance mandates.
- Expanding the use of health savings accounts, potentially to all Americans, including Medicare enrollees.
- Promoting association health plans and short-term, limited-duration insurance plans.
- Promoting Medicare Advantage plans and others that "encourage value, competition and choice."
6. The last area aims to make healthcare more consumer-focused. Recommendations include:
- Increasing price transparency.
- Making it easier for patients to access their medical records.
7. The report was met with mixed reception from the hospital industry, particularly because it is so sweeping and many of the proposals are familiar. "Too many elements of the Administration’s report resort to the same old bromides that got us here in the first place, and would reverse the progress hospitals and others are hard at work on," said Chip Kahn, president and CEO of the Federation of American Hospitals. Mr. Kahn said FAH does support the overall aim of the report, as well as specific recommendations, such as those that promote telehealth and streamline quality reporting.
American Hospital Association Executive Vice President Tom Nickels said, "Based on our initial read, we are pleased by several of the proposals put forth in today's report, such as those to broaden providers' scope of practice and expand access to telehealth, which will improve access to care for patients." Both groups opposed lifting restrictions on physician-owned hospitals.
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