Becker's Hospital Review

7 Executive Briefing Sponsored by: The State of Healthcare Under Trump: 3 Key Observations T he days and weeks after President Donald Trump's victory in November 2016 were marked by uncertainty for healthcare executives across the country. Because most polls had hospital and health system leaders preparing for a different outcome, after the election they were left to determine if the results nullified their existing strategic plans — and more than six years of reform efforts under the ACA. "Each of the health systems I had an opportunity to chat with had an A plan and a B plan. I think pretty much everybody's plan was torn up and tossed aside on that election morning," said Peter Doerner, executive vice president and chief development officer of North American Partners in Anesthesia, a national, physician-led anesthesia and perioperative management company. The morning after the 2016 election, NAPA led an executive roundtable discussion, hosted by Becker's in Chicago, to explore how the results of the national and state elections may influence the direction of healthcare reform. At that time, the executives present largely agreed they planned to take a "wait-and-see" approach to strategy under the new administration, according to Mr. Doerner. Nearly one year later to the day, NAPA hosted a follow- up discussion at the Becker's Hospital Review 6th Annual CEO+CFO Roundtable on Nov. 14, 2017 to see if executives were still governing with a wait-and-see approach, or if a rollercoaster year of healthcare policy had changed strategic imperatives and shifted their thinking. Here are three key observations from the discussion. 1. On a policy level, nothing has materially changed — though that's not necessarily positive. No matter who voters wanted in the White House, Congress and state legislatures, the 2016 election held promise that the issues plaguing the healthcare industry would be addressed in one way or another, either by mending the ACA's flaws or scrapping it entirely. However, in the months since President Trump took office, Congress has not been able to agree on healthcare policy, so this promise has yet to be realized. While this makes for a predictable healthcare landscape, many of the existing challenges presented by the ACA have been prolonged or exacerbated. "From our perspective, nothing has really changed," said a regional CFO of a 44 bed-hospital system in the Midwest. "As far as the ACA goes, we thought there were major problems with it before the election …The way it was set up, it needed fixing, but conceptually we were on board." The CFO named Medicaid expansion as a challenge; in particular the lack of access to Medicaid providers for newly enrolled patients. In some of the states where his health system operates, he said Medicaid expansion has not improved population health because many physicians still refuse Medicaid patients. Other providers named the looming threat of narrow networks, which grew in popularity under the ACA, as a significant challenge. For example, an executive from an independent critical access hospital in the Midwest said narrow networks are an obstacle for her organization because it doesn't employ providers, and two large health systems operate clinics nearby. "We don't have employed providers, so we can't join an ACO. How do we continue to be viable and independent and gather everyone together to take care of community, while we have narrow networks coming through that could potentially squeeze us out without us knowing?" she said. Similar to Medicaid expansion and narrow networks, executives noted the growth of high-deductible health plans under the ACA solved the health insurance coverage problem, but not necessarily the access to care problem. A regional CEO of a multistate health system in the West said the biggest issue her system faced this year was educating patients about what their HDHPs really meant in terms of out-of-pocket payments. "If you have a $10,000 deductible, that's self pay in my mind," she said. "People think they have insurance until they come to our facility. We have to educate them and say, 'You need to understand, you don't really have insurance.'" 2. Providers are rethinking the way their hospitals and networks are designed.

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