Q&A with ACP's Bob Doherty on future of healthcare

Physicians should prepare for uncertainty coming out of Washington, D.C. because President Donald Trump is poised to shake up healthcare policy, says Robert Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians (ACP).

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In fact, Trump’s early executive orders, including a travel ban involving seven Middle Eastern countries and loosening of regulations in regards to the Affordable Care Act (ACA), have already created confusion for both physicians and patients, Doherty told Medical Economics.

“I think we are in an era of major disruption and it’s not entirely clear yet what policies the administration and Congress will pursue and in what order,” he says.

Robert Doherty

Trump’s unpredictability makes it difficult to gauge where healthcare policy will move under his leadership and that of the Republicancontrolled Congress. Doherty says the ACP is working to provide clarity to physicians on some major issues, including Obamacare, Medicare payment reform, electronic health records (EHRs) and administrative burdens.

Q: Medical Economics: Is there any sense of what the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be like under the Trump Administration? Are they committed to value-based care?

Doherty: I think they are committed. Remember, MACRA was passed by a huge bipartisan majority and passed by a Republicancontrolled Congress. So this has the Republican brand all over it. In his confirmation hearings, Dr. Price [Tom Price, MD, secretary of the U.S. Department of Health & Human Services] indicated he remained supportive of the goals of that law, to move it toward value-based payment.

I do think Dr. Price comes at issues from the perspective of not wanting to put unnecessary burdens on doctors. He’s been very strong in his belief that the doctor-patient relationship needs to be protected from intrusions from third-party payers, including the government. Dr. Price did vote for MACRA, by the way.

Next: Will Congress continue to push doctors to use EHRs?

I would expect as HHS secretary that Dr. Price would be receptive to potential changes to ensure there aren’t excessive burdens placed on physicians that don’t generate greater value, to try to make sure the transition is such that there are opportunities for physicians in all specialties to get on the value-based payment train. I think there will be a hard look at the quality measures that are used: Are they meaningful, do they really help to improve patient care? … It’s not value-based payment if the measures you use to assess value aren’t good measures …

Q: Medical Economics: Do you think this administration and Congress will continue to push doctors to use EHRs?

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Doherty: I don’t think the push for EHRs will lessen. I don’t think anyone wants to go back to a world where almost everything is documented on paper. Interesting, as much as physicians are frustrated with EHRs-and that’s not all because of the government- very few that have adopted EHRs would ever go back to paper charts. So I don’t think the push to get EHRs universally adopted is going to go away, I don’t think the push to achieve true interoperability is going to go away - it’s one of physicians’ main frustrations.

There may be some efforts to look at the penalties. A very large number of physicians are getting Meaningful Use penalties this year. I wouldn’t be surprised to see some interest in easing those penalties. When you have very large numbers of physicians failing to meet the requirements of a regulatory program, you have to ask the question: Is it the regulatory program’s fault or is it the docs’? The numbers are so big, there are reasons to suggest it’s the program itself that’s problematic.

Now remember, MACRA is transitioning away from meaningful use (MU) to advancing care information (ACI). Congress really wanted to ease the burden with complying with what had been MU before, and making the goal to promote use of EHR systems that truly are shown to improve patient care. There’s still too much of a pass-fail philosophy in the ACI program. That was an area in the final rule that [the ACP] and others felt they didn’t go far enough under the previous administration. So I think that’s an area ripe for improvement as well.

I still think you’re going to see carrots and sticks, though. MACRA is a carrot-and-sticks system, but even that’s an improvement over MU, because MU right now is only sticks. … I do think there’s a lot that can be done under the ACI program to work with the vendors to make EHRs more relevant and useful, to avoid unnecessary clicks and pop-up reminders that drive doctors crazy, and improve patient safety.

Next: Eliminating the red tape

Q: Medical Economics: What are some ways ACP and other physician organizations can advocate in Washington on behalf of small practice physicians?

Doherty: The administrative burden is the number one thing I hear when I go around the country and talk to doctors. … While administrative burden affects all physicians, primary care physicians get the brunt of it. Everything in healthcare comes down on them, whether its preauthorizations or second-guessing everything they do.

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At ACP, we have an initiative called “patients before paperwork” where we are really going to challenge administrative requirements, tasks and regulations that are imposed upon physicians and detract from the physicianpatient relationship. We all recognize that some regulation is necessary and appropriate, but in many cases it’s either a requirement that has no justification or has been shown to not really achieve the results it was intended to achieve, or maybe there’s just a better way of doing it.

We’re going to be coming up with some comprehensive recommendations over the next several months to address some of that. Some will be taken to Congress and HHS, because some of it is the government, but I can also tell you the private sector and private insurance industry is a big part of that as well.

For small practices under MACRA, the ability for them to participate in alternative payment models (APMs) is huge. You can get bonus payments and incentives for being an APM. So far, most of the APMs are more suitable for larger systems, so we need to find APMs that work for small practices. We need to find ways for small practices to virtually group together as an APM to achieve economies of scale.

If you can eliminate red tape and regulations and create more opportunities for small practices to participate in APMs, I think that would be a huge help to physicians in small practices.