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February 15, 2017

The Effects of a Trump Presidency on Value-Based Care and Healthcare Revenue Cycle Management

Image 1: Healthcare Revenue Cycle Management Through Improved Data Analytics

Differences in political opinion aside, the United States will undergo significant policy changes under a Trump administration. The Republican party say they want a total repeal of the Affordable Care Act

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(ACA). In reality, legislators know that a complete repeal is impossible without Democratic support and doing so would leave at least 20 million previously uninsured Americans, who were covered through health exchanges, without health insurance again.

For this reason, value-based care will most likely remain with some ACA changes affecting healthcare revenue cycle management.

Possible ACA Changes Under Trump’s Administration

A number of popular Republican provisions plan to revise the ACA. Republicans want to remove tax subsidies for premiums, decrease Medicaid expansion and reduce taxes levied to pay for some of the ACA’s provisions. House Speaker Paul Ryan (R-WI) talked about a framework for maintaining preventive services, population health management and provision of broad coverage.

Furthermore, the Patients’ Choice Act (PCA) aims to transfer more responsibilities from payers to individual states, as it eliminates the exchange and prefers state-level marketplaces. The PCA also scraps the individual mandate. Premium prices would be controlled for the payer side via an incentive system that rewards insurers who include higher-risk patients. Patients will be permitted to automatically enroll in their plans too. This can reduce confusion on the complicated open enrollment periods. Patients will also gain eligibility for tax credits, in case they lose coverage. The PCA will also promote the use of health savings accounts (HSAs). They are tax-free accounts enabling patients to pay for out-of-pocket expenses or look for care which their plans do not cover. Value-Based Care Remains

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Despite these changes, Medicare would remain in the value-based care path, especially since Republican reforms affirm its goals of improving healthcare providers’ accountability for services provided to patients and increasing the financial accountability of healthcare organizations. Republicans agree with pay-for-performance incentives that can boost care quality for seniors, while cutting unneeded costs. Furthermore, patients who have the same insurance may have higher deductibles and out-of-pocket costs with PCA, which makes a value-based approach even more essential to patient-centered healthcare for the privately insured.

What a Trump Presidency Means for Healthcare Revenue Cycle Management

Despite some ACA changes, value-based reimbursement adoption will continue. Health Catalyst’s 2016 survey showed that less than a fourth of hospitals are on track for linking 50% of Medicare payments to a value-based payment model by next year.

To respond to these changes, healthcare revenue cycle management should focus on enhanced data analytics tools, population health management and patient billing techniques. Providers need to increase investment on in-house data analytics infrastructure or purchase vendor-sponsored systems to help examine quality metrics and oversee how hospitals are doing with value-based care improvements. They also need to look for strategies in boosting population health management programs that focus on at-risk groups, namely baby boomers and the chronically ill.

Lastly, providers must enhance front-end revenue cycle management techniques. Improving healthcare transparency and conducting patient engagement strategies can lead to higher payment collection.

Value-based care will survive Republican changes seeking to make healthcare organizations more accountable for financial costs and quality care too. The challenge is for hospitals to tweak healthcare revenue cycle management especially in the areas of data analytics tools, population health management and patient billing techniques to help reduce costs and increase collections.

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About DECO: For more than twenty years, we have been providing tailored solutions to hospitals, in order to help maximize third party self-pay revenue reimbursement. We support healthcare revenue cycle management through our proprietary, in-house designed Eligibility Management software, recovery management services, dedicated disability advocacy team, and a staff of Certified Application Counselors.

Sources: Preparing the Healthcare Revenue Cycle for Value-Based Care, What a Trump Presidency Means for Value-Based Care and the ACA,

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The effects of a trump presidency on value based care and healthcare revenue cycle management  

Under Trump, value-based care will likely remain. Healthcare revenue cycle management needs to boost data analytics and population managemen...