SUMMARY:
Where the least amount of doubt appeared was in response to anticipated policy changes should Trump/Pence prevail in November. Should Trump win, over 75% of industry executives expect the further dismantling of the Affordable care Act. Almost 60% expect continued efforts to control drug prices. 340B pharmacy programs represent a significant source of income for cash strapped hospitals, thus further reductions to the program are of concern. Along political lines, comments were left expecting further reductions and more inequality as well as greater transparency and better rural options the CAH.
As might be expected, should Biden/Harris prevail in November, expectations flip. Over 73% of respondents expect Medicare-for-All type coverage with opt outs for commercial plans a real possibility. Over 68% expect the intent and provisions of ACA to be strengthened. 44% anticipate the strengthening of consumer safety protections. Over 42% expect measures to control pharmaceutical pricing to go ahead under Biden/Harris, too. Almost 30% expect great scrutiny where mergers and acquisitions are concerned. The politics of the nation are as starkly represented in the hospital boardroom as anywhere and everywhere else in the Republic.
As to which administration would prove more beneficial to the future of American healthcare, again, much like in the country at-large, results were decidedly split. Almost 46% of industry executives think Trump/Pence better for the future of American healthcare, while over 41% lean Biden/Harris. But almost 13% of respondents were undecided. The obvious conclusion to draw is that no one is certain of the direction American healthcare is likely to take. The general contours of policy seem predictable in either case, but overall, the future seems uncertain and our results reflect industry anxieties.
We asked regarding 8 different industry changes seemingly on the horizon and 5 of them had a 45% response or more. Two came in at over 60%. Over 65% of respondents expect changes in payer contracting as a result of process transparency regulations and the posting of payer-negotiated rates. Over 61% expect the shift from hospital-based services to more consumer-friendly venues, like freestanding clinics, IDTFs and birthing centers, to continue. Over 55% expect additional reporting requirements and other restrictions regarding 340B. Over 46% expect the implementation of bundled payments for post-acute care. Almost 45% anticipate the reimbursement of site neutrality for ASCs and hospital outpatient departments. In short, healthcare execs expect industry changes already underway to continue, but beyond that remain uncertain as to the direction the industry will take.
Changes underway with the greatest impact on planning best shows where the industry is right now. Almost 72% of respondents are planning for the continuation of some, but not all, of the regulatory flexibilities surrounding telehealth. Clearly, the industry is planning on telehealth as a significant part of the industry going forward. The exact same number of respondents expect further reductions in Medicare reimbursements for 340B drugs as well as a reduction of roughly $500 million dollars in uncompensated care payments from Medicare. Almost 37% await the elimination of the Inpatient Only List, and the further expansion of the ASC covered procedure list. Almost 35% expect reductions in Medicare Physician Fee Schedule reimbursements. Almost 30% expect small increases in reimbursements from Medicare for inpatient and outpatient/ASC assuming compliance with quality reporting. Several report that Price Transparency Regulations will add significantly to industry expenses.
84% 0f respondents report that their organizations are reviewing internal diversity and inclusion efforts. Less than a third are creating committees or programs to directly deal with Diversity and Inclusion issues. The increased Covid infection rates for African Americans and Latino’s is viewed as parallel to diabetes rates and are viewed and handled in that light.
Telehealth is another matter. Almost 65% have initiated or expanded consumer marketing campaigns for telehealth services. Over 55% have redesigned or newly constructed space for telehealth services. Over 16% have created a new leadership position to manage these services. And over 17% have changed physician compensation formulas to adjust to the new reality. Almost everyone thinks telehealth is here to stay.
In what non-hospital areas are providers investing, developing anew, or exploring partnering? Almost 36% are investing in outpatient behavioral health. Over 27% are expanding their ASCs. Almost 18% are pursuing IDTFs; over 13% specialty pharmacies; and almost 16% are pursuing FQHC partnerships. Clearly, most hospitals are pursuing revenue wherever revenue can be found efficiently.
Published: October 7, 2020
