Federal Health Policy Greatly Determines

How Hospitals Can Innovate. Integrate.

Motivate!

May 18, 2017

River City Hotel

St. Louis, MO

Overview

• Overview of AHA

• Elections matter

• Repeal of ACA: Significant

consequences

• What’s next?

AHA Vision and MissionVision

A society of healthy communities, where all

individuals reach their highest potential for

health.

MissionThe mission of the AHA is to advance the

health of individuals and communities. AHA

leads, represents, and serves hospitals, health

systems, and other related organizations that

are accountable to the community and

committed to health improvement.

AHA’s Vision and Mission

AHA Strategies

Advocacy and Representation with Allied Associations

Thought Leadership

Knowledge Transfer

Agent of Change

AHA’S KEY ROLES

Redefining the H:

Different Models with

Multiple Paths and

Differing Pace of Change.

Environmental

Drivers of

Change

With

Opportunities

And

Challenges.

Redefining the A through:

Advocacy;

Thought Leadership;

Knowledge Transfer; and

Agent of Change.

Hospitals Driving Transformation

• Economic Contributors: Hospitals employ more than 5 million people,

making them America's second-largest source of private-sector jobs.

• Gateways to Care: We serve every type of community: urban, rural,

large and small. We are constantly working to improve access to

care for all patients from newborns to seniors.

• Centers of Innovation: We're bringing the latest medical innovation

and technology to patients, providing highly specialized health care.

• Improving Community Health: Our mission goes beyond treating

illness. We strengthen communities by working not just to mend

bodies, but to make people and communities healthier.

• Committed to Quality and Safety: We're dedicated to improving

patient quality and safety in every community.

Hospitals are:http://www.aha.org/advocacy-issues/initiatives/hosp-story-index.shtml

Diversity and

DisparitiesA Benchmark Study of U.S. Hospitals in

2013

8

National Call to Action Partners

Started in 2011

Video: #123forEquity Campaign

https://www.youtube.com/watch?v=gLeBhKsEXKs&feature=youtu.be

Major Provisions• Repeals individual mandate

Continuous enrollment requirement

• Repeals employer mandate

• Tax credits for private insurance

• Medicaid

Repeals increased match for expansion

population on December 31, 2019

$10 billion over 5 years for “safety net funding”

Per-capita caps/block grants starting in FY 2020

• State innovation fund: $138 billion over 9 years

• Repeals taxes

Key Provisions of AHCA

Details of AHCA

Changes made to accommodate their concerns

Option for states to chose Medicaid block

grant

Work requirements for Medicaid “able

bodied” childless adults

State option to partially reduce essential

benefits requirements

$15 billion/9 years to establish “invisible risk

pool”

What did Freedom Caucus Want?

• Allows states to opt-out (via waiver) of consumer/patient protections (Title I)

regarding requirements related to:

Rating rules based on age (2018)…3:1/5:1 (AHCA)+;

Insurers can charge higher prices to those individuals

who fail to maintain continuous coverage (2019);

Minimum essential benefits (2020); and

Maintains ban on pre-existing conditions…

but does not limit charging higher

premiums to “older and sicker” consumers

In summary, an end to community rating…return to medical underwriting

• Expedited state waiver process

(meet one requirement):

Establish risk pool (“invisible pool”)

Reduce average premiums

Increase enrollment

Stabilize insurance market

Stabilize premiums for individuals with preexisting conditions

Increase choice of health plans

MacArthur Amendment

Upton Amendment

$8 Billion over 5 years to States with

waivers from community rating

Reduce premiums or other out of

pocket expenses of individuals who

have an increase in monthly premium

due to waiver

HHS Secretary to allocate funds

Our message on ACA

• Maintain coverage for all individuals currently receiving benefits

• ACA should not be repealed without having a replacement guaranteeing adequate

coverage If that doesn’t occur…then hospital and health system payment cuts for Medicare and Medicaid must be restored

• Support continued efforts to transform delivery system from FFS to FFV using

coordinated care and integrated delivery mechanisms…key to affordability

• Enact regulatory relief that reduces burden…and allows more resources to be

used for patient care vs. paperwork

• Medicaid restructuring—in the form of block grants and per-capita caps—should

not be used as a vehicle to make budget cuts in an under-funded program Additional “flexibility” can be provided to the states through

waivers with safeguards for adequate funding and coverage

Expansion and non-expansion states must be treated equitably

• Prevent further reduction in payment for

hospital and health system services

• Medicaid

Reduce $880 billion budget reduction

If movement toward per-capita caps/block grants…adjust

trend factor/inflator and account for special health and

economic circumstances

Maintain full federal match for Medicaid population

Provide assistance to non-expansion states by increasing

new funding with direct support for hospitals health

systems

Use waivers with safeguards for coverage and payment as

preferred method to provide flexibility to states

• Adjust tax credits: increase base amount and support to low

income and 50-64 year old population

• Restore cuts in hospital payments

AHA priorities on AHCA

Resources to assist members

Summaries, factsheets

and analysis

Podcasts with

latest messages &

updatesTown Hall

webcasts

Downloadable

PowerPoint slides

Congressional

resourceswww.aha.org

Advocacy Tools

Proposed market stabilization rule• Special enrollment periods

Limit use

Verify eligibility prior to enrollment using an SEP

• Guaranteed issue

Allows insurers to require repayment of past debt prior to re-

enrollment

• Actuarial value

Allow greater variation in cost-sharing to reduce premiums

• Network adequacy

Rely on states for rules and oversight

Decrease essential community provider contracting from 30

percent to 20 percent

• Bid submission timeline

Extend deadline by six weeks

• Open enrollment periods

Reduce enrollment from 3 months to 6 months

Getting ready for the Senate

• New federal fiscal year begins (FY 2018)…

government funding

• Medicaid DSH

• Medicare payment extensions

• CHIP extension

• User fee act expirations (Drugs and medical

devices)

Other AHA priorities

Coming at hospital and health systems

Offsets: regular menu…site neutral

Physician-owned hospitals

340B

Appropriations (NIH, health and

education programs)

Post acute payment reform

Tax reform

Annual Medicare payment regulations

(Medicare DSH)

Other items on our agenda

Coming at us (continued)

Post acute care payment reform

VA Choice Act

Vulnerable communities

Regulatory relief

Antitrust reform (SMARTER Act)

Drug pricing

Other items on our agenda

IPPS Proposed Rule FY 2018

• ATRA coding cut

• CAH 96-hour Rule

• Reduced eCQM burden

• 90-day MU reporting period

for CY 2018

• Readmission SES adjustment

• DSH changes

• Comments due June 13

Highlights

• Proposed increase of $1 billion for FY 2018

• Proposed three-year phase-in to Worksheet S-10 data

− Would use FY 2014 Worksheet S-10 data + FYs 2012 and

2013 Medicaid Days and FYs 2014 and 2015 Medicare SSI

data

− Auditing process

• DSH Advisory Committee Reconvened

• Calls May 4, May 18, June 6

Medicare DSH Payments

CMS Continues Changes in FY 2018

Cyber Security: AHA’s Focus

• Work with law enforcement and security experts to address sources of attacks, how and when to engage law enforcement, and examples of best practices

Federal Health Policy Greatly Determines

How Hospitals Can Innovate. Integrate.

Motivate!

Kim Byas, Sr., PhD, MPH, FACHE

kbyas@aha.org

312-422-2885