[{"innerBlocks":[],"name":"core\/freeform","postId":126253,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"As the Trump administration moves into its second full year, there are many updates to U.S. healthcare policy to take into account. From attempts to repeal the Affordable Care Act to naming a new HHS secretary, change is buffeting the healthcare sector.

Many of these challenges will have either direct or indirect effects on how organizations use healthcare information technology in the coming years.

Here\u2019s a rundown of the regulatory landscape for the upcoming year.

The Republican tax bill and ACA\u2019s individual mandate<\/b>
In December, the Republican tax bill passed and President Trump signed it into law. The tax bill didn\u2019t repeal the individual mandate, which is the ACA\u2019s provision that requires folks who don\u2019t qualify for a hardship exemption to carry a minimum level of health coverage. Technically, it eliminated the penalty for not having health insurance in the year 2019 and onward.

Under ACA, the penalty is either a flat dollar amount, which is $695 for an adult, or 2.5 percent of the household income above a certain threshold, whichever is greater. The tax bill modified that penalty to zero dollars and zero percent in 2019. The Congressional Budget Office (CBO) estimates taxpayers will avoid an estimated $43 billion in penalties they would otherwise pay through 2027.

In all reality, whether it\u2019s called eliminating the mandate itself or eliminating the penalty, it essentially has the same effect as eliminating the mandate altogether. This will have some significant effects on the health insurance market, but in general, eliminating the penalty associated with the mandate won\u2019t affect most people. That\u2019s because the majority of Americans receive health coverage through their employer or through a public health program like Medicare, Medicaid or similar. Private individual insurance markets are meant for people who are either self-employed or don\u2019t have access to employer coverage and make too much money to qualify for a safety net program like Medicaid.

For those 22 million individuals who do use the individual market, we expect to see it look very different moving forward. The CBO estimates that repealing the individual mandate will result in 4 million people losing coverage in 2019; that number will eventually grow to 13 million people. This means that many healthy people may voluntarily opt to go without coverage. As a result, insurers may raise their premiums to cover the remaining population who, in all likelihood, will be sicker. These higher premiums could cause more consumers to become priced out of the market. Bipartisan efforts are being made to address the issues with the individual market.

The point of the individual mandate was to make sure not only sick people bought health insurance in those markets. The idea was that by widening insurance risk pools, premiums would go down in the overall market, reducing the likelihood that people only signed up for insurance when they were sick. Without these penalties, the CBO has predicted that wealthier people may choose to forego coverage altogether. In addition, poor people who are medically needy may not sign up for insurance because they don\u2019t have the same sense of urgency to enroll. The CBO predicts that the premiums in the market will spike 10 percent without this individual mandate, as the exchanges are left with this sicker consumer pool.

Most people left in the marketplace will continue to receive subsidies, and there\u2019s a chance they\u2019ll be insulated a bit from those premium increases. For the people who don\u2019t receive subsidies, the higher premiums could be very problematic.

What happens next for healthcare is unclear. Hospitals and healthcare organizations will likely see fewer patients with insurance coverage. Whether that translates to hospitals having higher dollars in uncompensated care, or perhaps more patients in repeatedly using the emergency department with fewer visits for preventative care, is not clear. What will help us better understand the eventual effects will be what happens next to the remaining revisions in the Affordable Care Act.

The future of the ACA<\/b>
Right now, we\u2019re seeing a shift in public policy that really represents a philosophical divide in our nation\u2019s culture.

At the core of the ACA was the notion that healthcare in the United States should be accessible and affordable to everyone, and that the federal government should play a major role in ensuring that. As a result, we saw a more regulated industry, with constraints on business practices of insurers and healthcare providers.

Today, we\u2019re debating bigger questions: Is healthcare coverage a fundamental right, a privilege or neither? How involved should the government be in healthcare? What is our role as individuals to be accountable for our own health decisions and lifestyles vs. what the government should compel us to do?

The confirmation of Alex Azar as HHS secretary<\/b>
Alex Azar, a former top pharmaceutical and government executive, has just been confirmed as the new secretary of Health and Human Services. Based on his background, Azar is an interesting choice to head up a $1 trillion department responsible for major health insurance programs, including Obamacare, as well as medical research, food and drug safety and public health.

Experience in healthcare is an obvious asset for the leader of what is arguably the nation\u2019s most important healthcare agency. President Trump, Republicans and healthcare industry leaders are impressed with Azar\u2019s background. He led a pharmaceutical company and spent several years in HHS under George W. Bush\u2019s administration. He also helped implement prescription drug benefits and helped establish the Office of the National Coordinator. He has an expectation and an understanding of what health IT should look like.

Azar has mentioned that he wants to focus on using Medicare to continue shifting the health system from a fee-for-service model to health outcomes. As a part of that effort, he has mentioned a willingness to support mandatory payment models. Last fall, we saw the administration cancel several mandatory bundle payment systems and roll back the Comprehensive Care for Joint Payment (CJR) bundle payment model. Azar\u2019s selection perhaps signals that he\u2019s not completely on board with the administration\u2019s policy around voluntary programs versus mandatory. He seems willing, once a pilot has been proven and makes sense, to use a little bit more of an aggressive policy lever through Medicare to enact some of those changes.

He has also mentioned addressing opioid abuse. We should expect him to approach this with an eye toward health policy and a very conservative view.

The impact of Cures Act and TEFCA<\/b>
Obama signed the Cures Act into law at the end of 2016, allocating $10.5 billion with goals of reducing the burdens of providers using electronic health records and advancing interoperability. It\u2019s a hefty act that requires the ONC to facilitate the \u201ctrusted exchange\u201d of electronic health information across healthcare networks.

The 21st Century Cures Act is a huge, sweeping piece of legislation. It contains many provisions related to health IT and interoperability, for example. The prohibition against data blocking is something that we expect soon, and hopefully, we\u2019ll see some clarifying legislation in the coming months.

The Trusted Exchange Framework and Common Agreement (TEFCA) is the most recent regulation that we\u2019ve seen proposed out of ONC, targeting the overall connection of health information exchanges (HIE) through a network of networks. It\u2019s going to create a single \u201con-ramp\u201d for that HIE. For example, healthcare providers in Missouri won\u2019t don\u2019t need to worry about their connection in Florida. Rather, they\u2019re going to be focused on their state HIE that connects to Florida. I think providers are excited there\u2019s not going to be a one-to-many connection they\u2019ll have to worry about supporting.

We\u2019ll also see the introduction of health information networks (HIN), entities that would automatically connect and participate in this nationwide HIE. Now we\u2019re seeing TEFCA establish Qualified Health Information Networks (QHIN), which will be that on-ramp vehicle. They\u2019ll facilitate the standard methodology for the HIE connectivity.

The compelling part of TEFCA is that it\u2019s a voluntary program. This indicates that the ONC believes a private sector organization is the best way to facilitate interoperability. Right now, we don\u2019t see any penalties associated with providers for not joining a QHIN, but penalties may come at some point.

Healthcare regulatory policy in 2018<\/b>
We should expect to see a continued advancement in value-based payment, which seems to be the one message that receives bipartisan support across the industry. The days of generating fees-for-service to increase revenue are over.

With the digitization of electronic health care data, we\u2019re going to continue seeing innovations. That\u2019s going to create some interesting challenges. Data access rights, privacy and other related policy needs to be addressed to bridge data and business models from non-healthcare industries. Each industry has grown up with its own expectations around data access, use and agreements. We will probably see some significant changes happen to HIPAA, for example, to accommodate what we need in the health care space.

This blog post originally published on Cerner.com. Click here<\/a> to view the original content.<\/i>","saveContent":"As the Trump administration moves into its second full year, there are many updates to U.S. healthcare policy to take into account. From attempts to repeal the Affordable Care Act to naming a new HHS secretary, change is buffeting the healthcare sector.

Many of these challenges will have either direct or indirect effects on how organizations use healthcare information technology in the coming years.

Here\u2019s a rundown of the regulatory landscape for the upcoming year.

The Republican tax bill and ACA\u2019s individual mandate<\/b>
In December, the Republican tax bill passed and President Trump signed it into law. The tax bill didn\u2019t repeal the individual mandate, which is the ACA\u2019s provision that requires folks who don\u2019t qualify for a hardship exemption to carry a minimum level of health coverage. Technically, it eliminated the penalty for not having health insurance in the year 2019 and onward.

Under ACA, the penalty is either a flat dollar amount, which is $695 for an adult, or 2.5 percent of the household income above a certain threshold, whichever is greater. The tax bill modified that penalty to zero dollars and zero percent in 2019. The Congressional Budget Office (CBO) estimates taxpayers will avoid an estimated $43 billion in penalties they would otherwise pay through 2027.

In all reality, whether it\u2019s called eliminating the mandate itself or eliminating the penalty, it essentially has the same effect as eliminating the mandate altogether. This will have some significant effects on the health insurance market, but in general, eliminating the penalty associated with the mandate won\u2019t affect most people. That\u2019s because the majority of Americans receive health coverage through their employer or through a public health program like Medicare, Medicaid or similar. Private individual insurance markets are meant for people who are either self-employed or don\u2019t have access to employer coverage and make too much money to qualify for a safety net program like Medicaid.

For those 22 million individuals who do use the individual market, we expect to see it look very different moving forward. The CBO estimates that repealing the individual mandate will result in 4 million people losing coverage in 2019; that number will eventually grow to 13 million people. This means that many healthy people may voluntarily opt to go without coverage. As a result, insurers may raise their premiums to cover the remaining population who, in all likelihood, will be sicker. These higher premiums could cause more consumers to become priced out of the market. Bipartisan efforts are being made to address the issues with the individual market.

The point of the individual mandate was to make sure not only sick people bought health insurance in those markets. The idea was that by widening insurance risk pools, premiums would go down in the overall market, reducing the likelihood that people only signed up for insurance when they were sick. Without these penalties, the CBO has predicted that wealthier people may choose to forego coverage altogether. In addition, poor people who are medically needy may not sign up for insurance because they don\u2019t have the same sense of urgency to enroll. The CBO predicts that the premiums in the market will spike 10 percent without this individual mandate, as the exchanges are left with this sicker consumer pool.

Most people left in the marketplace will continue to receive subsidies, and there\u2019s a chance they\u2019ll be insulated a bit from those premium increases. For the people who don\u2019t receive subsidies, the higher premiums could be very problematic.

What happens next for healthcare is unclear. Hospitals and healthcare organizations will likely see fewer patients with insurance coverage. Whether that translates to hospitals having higher dollars in uncompensated care, or perhaps more patients in repeatedly using the emergency department with fewer visits for preventative care, is not clear. What will help us better understand the eventual effects will be what happens next to the remaining revisions in the Affordable Care Act.

The future of the ACA<\/b>
Right now, we\u2019re seeing a shift in public policy that really represents a philosophical divide in our nation\u2019s culture.

At the core of the ACA was the notion that healthcare in the United States should be accessible and affordable to everyone, and that the federal government should play a major role in ensuring that. As a result, we saw a more regulated industry, with constraints on business practices of insurers and healthcare providers.

Today, we\u2019re debating bigger questions: Is healthcare coverage a fundamental right, a privilege or neither? How involved should the government be in healthcare? What is our role as individuals to be accountable for our own health decisions and lifestyles vs. what the government should compel us to do?

The confirmation of Alex Azar as HHS secretary<\/b>
Alex Azar, a former top pharmaceutical and government executive, has just been confirmed as the new secretary of Health and Human Services. Based on his background, Azar is an interesting choice to head up a $1 trillion department responsible for major health insurance programs, including Obamacare, as well as medical research, food and drug safety and public health.

Experience in healthcare is an obvious asset for the leader of what is arguably the nation\u2019s most important healthcare agency. President Trump, Republicans and healthcare industry leaders are impressed with Azar\u2019s background. He led a pharmaceutical company and spent several years in HHS under George W. Bush\u2019s administration. He also helped implement prescription drug benefits and helped establish the Office of the National Coordinator. He has an expectation and an understanding of what health IT should look like.

Azar has mentioned that he wants to focus on using Medicare to continue shifting the health system from a fee-for-service model to health outcomes. As a part of that effort, he has mentioned a willingness to support mandatory payment models. Last fall, we saw the administration cancel several mandatory bundle payment systems and roll back the Comprehensive Care for Joint Payment (CJR) bundle payment model. Azar\u2019s selection perhaps signals that he\u2019s not completely on board with the administration\u2019s policy around voluntary programs versus mandatory. He seems willing, once a pilot has been proven and makes sense, to use a little bit more of an aggressive policy lever through Medicare to enact some of those changes.

He has also mentioned addressing opioid abuse. We should expect him to approach this with an eye toward health policy and a very conservative view.

The impact of Cures Act and TEFCA<\/b>
Obama signed the Cures Act into law at the end of 2016, allocating $10.5 billion with goals of reducing the burdens of providers using electronic health records and advancing interoperability. It\u2019s a hefty act that requires the ONC to facilitate the \u201ctrusted exchange\u201d of electronic health information across healthcare networks.

The 21st Century Cures Act is a huge, sweeping piece of legislation. It contains many provisions related to health IT and interoperability, for example. The prohibition against data blocking is something that we expect soon, and hopefully, we\u2019ll see some clarifying legislation in the coming months.

The Trusted Exchange Framework and Common Agreement (TEFCA) is the most recent regulation that we\u2019ve seen proposed out of ONC, targeting the overall connection of health information exchanges (HIE) through a network of networks. It\u2019s going to create a single \u201con-ramp\u201d for that HIE. For example, healthcare providers in Missouri won\u2019t don\u2019t need to worry about their connection in Florida. Rather, they\u2019re going to be focused on their state HIE that connects to Florida. I think providers are excited there\u2019s not going to be a one-to-many connection they\u2019ll have to worry about supporting.

We\u2019ll also see the introduction of health information networks (HIN), entities that would automatically connect and participate in this nationwide HIE. Now we\u2019re seeing TEFCA establish Qualified Health Information Networks (QHIN), which will be that on-ramp vehicle. They\u2019ll facilitate the standard methodology for the HIE connectivity.

The compelling part of TEFCA is that it\u2019s a voluntary program. This indicates that the ONC believes a private sector organization is the best way to facilitate interoperability. Right now, we don\u2019t see any penalties associated with providers for not joining a QHIN, but penalties may come at some point.

Healthcare regulatory policy in 2018<\/b>
We should expect to see a continued advancement in value-based payment, which seems to be the one message that receives bipartisan support across the industry. The days of generating fees-for-service to increase revenue are over.

With the digitization of electronic health care data, we\u2019re going to continue seeing innovations. That\u2019s going to create some interesting challenges. Data access rights, privacy and other related policy needs to be addressed to bridge data and business models from non-healthcare industries. Each industry has grown up with its own expectations around data access, use and agreements. We will probably see some significant changes happen to HIPAA, for example, to accommodate what we need in the health care space.

This blog post originally published on Cerner.com. Click here<\/a> to view the original content.<\/i>","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

How healthcare’s regulatory landscape will affect HIT in 2018

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