Current divisions within the government and the upcoming election cycle has left the healthcare sector in turmoil. How will costs be managed through executive authority by the administration? Insurance, pharmaceutical prices and hospital costs will all be closely watched this year.
A Segregated Healthcare
How will the health sector be treated in the upcoming months and what will be the repercussions on the rest of the year? Some subjects that are sure to hit the surface in 2019 are:
1. Increased Importance on Prior Authorization Processes
Prior authorization processes have increasingly come to light as leading to serious adverse events. Required by some health insurers for tests, treatments and certain drugs, some prior authorization processes have not been reviewed in years.
Although many would say that most of the processes in place work for many, others would argue they need serious improvement. In the 2018 AMA Prior Authorization (PA) Physician Survey, 28% reported PA led to a serious adverse event. This study had 1,000 responding physicians; 40% were primary care physicians and 60% were specialists.
In a joint announcement with the release of the survey, the AMA Chair Jack Resneck, Jr., M.D. stated:
“The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care.”
We can be sure to expect emphasis on prior authorization processes in 2019 and beyond.
2. Drug Prices
Known as the “donut hole,” Big Pharma lost a $4 billion lobbying battle for Medicare Part D funds in 2018. The preliminary analysis of the Bipartisan Budget Act of 2018 included changes to Medicare and other programs including:
- Appropriated Programs
- Health Care Extenders and Policies
- The CHRONIC Care Act
- Excluded Priorities
- Offsets
- Next Steps
Leading to cut cost-sharing for seniors, who fall well under the “donut hole” coverage gap, it also led to increased financial liability for manufacturers. These have gone from 30% to 25% and 50% to 70% respectively.
With President Trump proposing to substantially reduce drug prices under Medicare, back in October 2018, by comparing them to costs in other industrialized countries, everyone will surely be on the lookout for any specifics.
3. Interoperability, as Always
As a subject of interest for many years now, the healthcare industry still strives to exchange information seamlessly from various technologies and break access barriers.
Changes to Meaningful Use and the introduction of a Promoting Interoperability category within MIPS is helping pave the way towards a technologically accessible future.
To reach interoperability, clinicians choose measures within MIPS and MACRA that advance the productive use of healthcare information. Provided through the ability to share this data with their peers or the patient themselves, the information can include test results, therapeutic plans, visit summaries and more.
Interoperability might not be a new subject, but it sure to be a recurring one that will hopefully one day be a reality for the healthcare industry and its professionals.
4. ACA Litigation Fallout
To keep, or not to keep, that is the question regarding the Affordable Care Act. In March of 2018, GOP-controlled Congress did not replace the Affordable Care Act, to the dismay of many and the relief of many others. If the ACA was to be repealed, would 12 to 14 million Americans lose Medicaid coverage?
However, in December of 2018, a federal judge in Texas ruled the ACA as “unconstitutional” because of its individual coverage mandate. Although it has no immediate impact on the ACA program itself, the decision rests in the hands of the 5th U.S. Circuit Court of Appeals and possibly the Supreme Court.
As the year progresses, all eyes will be on whether the pro “Medicare for all” political supporters will allow millions of Americans to keep their coverage by upholding the Affordable Care Act.
Any subjects you’d like to address that we haven’t? Tell us about it in the comments!