This is the second article in our series on the effect of a “slow repeal” of the ACA, which began January 3, 2017, when Senate Budget Committee Chairman Mike Enzi introduced a budget resolution with instructions to the relevant Senate and House committees to develop a plan to repeal the ACA. The four committees that control healthcare policy have until January 27, 2017, to draft reconciliation bills, which will address the important details, likely including how long it will take to replace the ACA, and which parts of the ACA will be repealed through a budget reconciliation process. On January 4, 2017, the Senate promptly voted (51-48) to begin debate on the procedures to repeal the ACA.
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Slow Repeal of the ACA and Its Effect on Health Systems
President-elect Donald Trump has said repealing the ACA will be a priority for his administration. On Dec. 6, 2016, Senate Majority Leader Mitch McConnell (R-Ky.) announced that a measure to repeal parts of the ACA will be the first item the Senate considers when it convenes on Jan. 3, 2017.
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What’s next for Trump’s HHS Secretary nominee?
One of President-elect Trump’s many campaign promises included “repealing and replacing” the Affordable Care Act (ACA), known as Obamacare. Trump nominated Rep. Tom Price, M.D. (R-Ga.) to serve as the Secretary for the Department of Health & Human Services. Trump’s selection of Price signals that Trump is pushing forward with his promise to aggressively repeal and replace the ACA. If confirmed, Price will lead 11 agencies, including the FDA and the National Institutes of Health, with a $1-trillion budget and the ultimate oversight responsibility for both Medicare and Medicaid.
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Could Your Facility Benefit from Telemedicine?
A study published in the February 2014 issue of Health Affairs concludes that the use of telemedicine by nursing homes can reduce hospitalizations and generate savings for Medicare. However, there are several barriers to successful implementation, including the cost of the technology, the willingness of staff to utilize the service and traditional Medicare and Medicaid payment methodologies.
The researchers noted previous studies suggesting that the lack of on-site physicians in many nursing homes during off-hours (evenings, weekends and holidays) may be one cause of inappropriate hospitalizations. Typically, if a medical issue arises off-hours, an on-call physician is phoned by nursing home staff. The physician can then either travel to the nursing home or, more likely, recommend that the resident be transferred to a hospital emergency room. Could the availability of telemedicine prevent some of these transfers?
Eleven for-profit Massachusetts nursing homes, owned by a single company, and all dually certified to accept both Medicare and Medicaid, were studied. All were very similar in terms of resident characteristics, staffing and quality scores. The nursing home residents received their primary care through physician group practices; prior to the study, most after-hours medical services involved the nursing home staff phoning the residents’ on-call physicians. Telemedicine services were introduced in six of the eleven nursing homes, with five serving as a control group. The six nursing homes utilizing telemedicine services each received a cart with equipment for two-way videoconferencing and a high-resolution camera for wound care. A remote medical call center staffed by an RN, a nurse practitioner and a physician provided the telemedicine services (most of the nursing home residents’ treating physicians had signed over their off-hours coverage to this remote center). Before the telemedicine service was introduced in the six nursing homes, separate training sessions were held for the direct care staff and the residents’ physicians. The annual cost of the telemedicine service was $30,000.00 per facility.
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