Is interoperability of healthcare information over before it really began?
With the election of Republican Donald Trump to the presidency last week, the future of all kinds of healthcare reform is uncertain. Trump’s promise to repeal the Affordable Care Act completely on his first day in office isn’t a done deal, given that certain provisions are popular even with Republicans.
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Some elements of healthcare reform — particularly those related to health IT — are either too far along, too deeply ensconced or too important to the ever-important hospital and physicians lobbies to undo.
One that’s too far along is Meaningful Use, since the money has been spent, though that program hasn’t yet produced the promised results of a secure, patient-centered, fully interoperable system of electronic health records. And one that’s too important probably is the Medicare Access and CHIP Reauthorization Act (MACRA), since that law is replacing the hated Medicare Sustainable Growth Rate, among other things.
As freelance journalist Rebecca Vesely, reporting for the Association of Health Care Journalists, noted, MACRA passed Congress with 91 percent support.
The recently finalized MACRA regulations haven’t been universally popular, so the incoming Trump administration still could put the brakes on the rollout. There is plenty of precedent for new administrations to review regulations put in place by outgoing presidents, especially when the party in power changes. President George W. Bush did exactly that with the HIPAA privacy, security and transaction rules written by the Clinton administration.
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MACRA incorporates the Meaningful Use Stage 3 rules into a broader program aimed at encouraging data sharing and better patient outcomes. Still, some believe interoperability could lose out in the new administration.
The team at Chilmark Research forecast how Trump might impact the health IT industry. Analytics stands to be a “big winner” under the new president, as does patient engagement, though the latter might be mostly because of the expansion of health savings accounts. HSAs can’t work on a wide scale without greater price and quality transparency, Chilmark Managing Partner John Moore noted in a blog post.
Interoperability could be a different story. “Despite bipartisan support, regulatory models for interoperability fall out of favor. Funding for [health information exchanges] evaporates,” Chilmark forecast. There may be a “modest uplift” from the desire to create “tight clinically integrated networks,” but not enough to offset the other setbacks.
That doesn’t necessarily change the imperative on healthcare systems, though.
“[D]ata exchange/interoperability will pull back from being a social/medical need that is mandated to being a business/market need that is economically driven,” Moore wrote.
He told healthcare organizations not to stray from the current trajectory toward data sharing and cooperation with competitors. “The need to continue to improve costs and quality metrics will continue unabated, requiring a long-term investment strategy in IT to facilitate cross-enterprise care delivery,” Moore said.
