On The Issues

December 1st, 2014

The New Congress and Healthcare

With the Committee Shifts in Congress, Expect to See More Focus on Innovation, Interoperability and Fee-for-Service Reform

The Republican takeover of the U.S. Senate and their additional seats picked up in the U.S. House should not disrupt, and could actually benefit, the momentum of several pending bills focusing on healthcare delivery and payment reform starting in 2015.

And putting aside contentious aspects of health reform or the Affordable Care Act, the Republican majority in the U.S. Senate still does not contain enough voting power such as a super-majority to over-ride the pillars of health reform, meaning the GOP and Democrats will have to work together on specific legislation. Where this relates to pending legislation that will fuel more stability in our healthcare system such as Fee-for-Service (FFS) or the Sustained Growth Rate (SGR) Formula Reform, this could be seen as good news since those major bills impacting healthcare already have bipartisan sponsorship and support.

Where the industry may see some pointed discussion is around the meaningful use program and interoperability. With more than $25 billion spent to date, there are questions on the progress of the EHR incentive program, and mounting discussion that interoperability is seen as lagging. We have even see these two topics emerge in the waning days of this lame duck session.

Last April, a group of six GOP senators released a report called “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT,” which critically examines both of these areas and now we could see Congress revisit these topics.

As to leadership roles, several U.S. House committees important as birthplaces of health IT legislation should remain stable, namely House Energy & Commerce, the Appropriations Health Subcommittee and the Ways and Means Health Subcommittee although the Ways and Means full Committee will have a new chairperson since U.S. Rep Dave Camp is retiring. I don’t see any major or fundamental policy shifts though with this leadership change.

On the Senate side, we will see more change but I see even more support for using innovation, interoperability and health IT as a key component of creating a smarter and sustainable healthcare system. The influential Senate Finance Committee will be led by U.S. Senator Orrin Hatch and the new Ranking Member would be current Chair, U.S. Senator Ron Wyden. Senator Wyden has been an ardent supporter of innovation and health IT through the years. I expect to see U.S. Senator Lamar Alexander take over as Chair of the Senate Health, Education, Labor and Pensions Committee (HELP) and potentially U.S. Senator Patty Murray taking up as Ranking Member but she would then need to think about possibly giving up her powerful ranking member position on the U.S. Senate Budget Committee.

Again, with all of these shifting seats and new leaders, I don’t see any major hurdles for innovation and opposition for crafting smarter policies to create a stable and sustainable healthcare system.
Here are a few important bills impacting healthcare delivery and heath IT advancement that should continue to receive bipartisan support:

  • Meaningful Use – A bipartisan bill from the House Energy & Commerce committee seeks to allow a 90-day reporting period for 2015 instead of an entire calendar year of data collection as currently required.
  • SOFTWARE Act – Also a bipartisan bill, the Act would establish a risk-based hierarchy framework approach to the use of health IT solutions aimed at patient safety, and would preclude the FDA from establishing regulatory oversight.
  • SGR Modernization Act – Again a bipartisan - and bicameral bill – that has found consensus across the aisle in both chambers, this bill has many components beneficial to healthcare delivery, health IT and Medicare payment structures. There is increasing support from the healthcare and health IT leaders to move this legislation forward before the new Congress convenes Jan. 3. The Act would phase out fee-for-service payments over time for a quality and value-based approach. Meaningful use reporting, interoperability gains and patient engagement are key components of that structure. Lawmakers face a deadline of March 31 to pass this bill or a variation (and find from between $140 to $180 billion to pay for it) or face yet another Medicare payment patch that would do little to advance quality or decrease healthcare costs.

Taken together, it should be an interesting – and likely positive – Congress for necessary advancements in creating an interoperable, more collaborative and sustainable healthcare system for America. Maybe we will even create a few best practices in this process that we can share globally and help lead the rest of the world through evolving their healthcare systems to increase quality and stabilize raising costs.