Mergers and acquisitions have been the hot talks in the healthcare landscape for many months now. Health systems are merging, insurers are merging, and many hospitals are buying physician practices at unprecedented rates. Earlier in the 90’s, hospitals started buying up practices and employing doctors, but the result was not like what was expected by the hospitals. Many of the hospitals ended up losing money before understanding that it was not a good idea. It is not yet revealed how today’s situation is any different.
Present Scenario In Healthcare
In November 2015, President Obama signed into law a bill that was intended to prevent and prohibit hospitals from billing “NEW” off-campus outpatient services making use of the HOPPS payment method. This was done after widespread buying of physician offices by hospitals and then making them into hospital outpatient departments.
A few weeks ago, the 21st Century Cures bill was passed, with an aim to increase FDA and NIH funding as well as biomedical research and drug approval process. After six months of enactment of the bill, MACs will be required to post a summary of evidence and explanation to the rationale to support NEW LCDs.
The 21st Century Cures bill also establishes a new Medicare payment and benefit system for “home infusion therapy.” This therapy includes the nursing education and training, and remote monitoring of systems and services that are linked to administering some of the infusion drugs in the home of a patient.
The Expected Changes
The healthcare reform ideas by elected president Donald Trump are sufficient to let the Affordable Care Act to collapse. It is expected that a Congress that is controlled by GOP could cancel the employer mandate, individual mandate, many taxes that are adopted as part of the ACA, and can withdraw much money that is collected to fund ACA.
Earlier, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), to revoke the SGR formula and replaced with two initiatives, the Medicare Incentive Payment System (MIPS) and Alternative Payment Models (APM). As MACRA was passed with bi-partisan support, major changes will not be made to it in the short term. However, when time for payment adjustments come (in 2019), there could be some pressure to offer relief to the Eligible Providers for payment reductions.