Analyst: Trump, GOP control could mean fast-track for legislation to help rural hospitals
iVantage exec says new administration could pay closer attention to the Save Rural Hospitals Act, a bill that was proposed in 2015.
Photo by: Texas.pics (Own work) [CC BY-SA 3.0], via Wikimedia Commons
A repeal of the Affordable Care Act by President-elect Donald Trump's incoming administration could spell disaster for rural hospitals, experts say, with special attention to legislation that may fill the gaps.
Since the law's implementation, rural hospitals have gotten a boost largely because more Americans now have health coverage. Whether a revamped healthcare system will erase those gains is anybody's guess.
Michael Topchik, national leader of the Chartis Center for Rural Health and head of business intelligence company iVantage, said there's the potential that a new administration would pay closer attention to the Save Rural Hospitals Act, a bill that was proposed in 2015 with bipartisan support.
The bill, which has been mired in gridlock since it was introduced, would provide rural hospitals with financial and regulatory relief to allow them to stay open and care for residents who are older, poorer and have higher rates of chronic disease than their urban counterparts.
"It attempts to deal with low volumes," Topchik said of the bill. "I think there's a potential for legislative relief now that you have one party controlling … the House and the Senate. This bill could finally get some face time and a vote. So that's a positive thing that could happen. Presumably the do-nothing Congress was the result of split government, so unified government could get some things moving."
[Also: Rural hospitals outperformed urban in value, readmissions, hospital acquired condition programs]
On the other side of that is the looming threat of ACA repeal, which could especially affect hospitals in states that have expanded Medicaid. Rural hospitals have been buoyed by the swelling rolls of the insured, and Topchik said ACA repeal hurt their bottom lines.
While he expects wholesale changes to the healthcare landscape, Topchik said it's hard to tell what those changes might be given the uncertainty as to whether certain provisions of the ACA may survive.
Either way, he said, the ACA created a sea change in the industry, aspects of which will likely continue.
"The ACA served as a catalyst to move the market from volume-based payments to value-based payments," he said. "The market is really full speed ahead, so a repeal of the ACA may not do much to reverse what is really a tidal shift in the industry moving from volume to value. The repeal, if that happens, is certainly going to affect the Medicaid programs that served as the umbrella to bring healthcare to low-income Americans. But the market is very much focused on population health now, and value-based payments. It's not going to be easy to go back."
[Also: Rural hospitals hardest hit by lack of Medicaid expansion, Health Affairs study shows]
Topchik said there will likely be more clarity on healthcare from the federal level near the end of the first quarter of 2017, or the beginning of the second quarter. Industry changes such as capitation, bundled payments and population health will likely survive, he said, and he remains hopeful that rural hospitals may finally get their due.
"I do think there's a lot of attention on both sides of the aisle to rural healthcare," he said. "It may finally get the attention it deserves. And it needs it, quite frankly. The policymakers are going to have to come to grips on what to do."
Twitter: @JELagasse
