The short answer is “Hospital executives should use the time to take stock.”
The passage by the House of Representatives of HR 1628, amended at the last minute to be more palatable to the ideologically diverse GOP majority in the House and just in time for a first-100-days (ish) win for the Trump administration, should be viewed as a shot across the bow for American hospitals and a wake-up call for executives accountable to boards of directors eager for reassurance.
Of course, Senate approval also is required, but that’s not the impediment many are hoping for. Senate action, which some predict to occur by September 2017 because of the coincidental timing of Budget Reconciliation 2018, will certainly be the GOP’s version of the “Big Bang,” with repeal and replace and tax reform fueling each other as they barrel through the Senate chamber, most likely requiring only a bare majority for approval, or even just 50-50 plus the Vice President. Before that, you should expect more than a few trips to the wood shed (i.e. The White House) for moderate Senate Republications with the looming specter of a Democratic majority in the House come 2019.
So break out your presentation software and start ticking through your to-do list:
- Medicaid expansion: The 2020 Medicaid expansion expiration in HR 1628 may stick in the final bill (although some are doubtful), so take inventory of what you have invested in caring for the expanded Medicaid population and figure out how to prepare for a resurgence of uncompensated care. If Medicaid expansion doesn’t expire, you’ll look like a hero.
- Exchanges and mandates: These will surely go, and quickly. Strike any hospital gains from the ACA from your fiscal 2019 budget and take a hard look at Cap Ex going forward.
- Medicare: This might be the cornerstone of your fiscal health. You should consider implementing and accelerating strategies to attract healthy seniors and expand your risk-taking appetite. Even with declining Medicare rates, this may be the biggest game in town.
- Community health centers: If you haven’t done so already, consider getting into the Federally Qualified Health Center game as a strategy to manage emergency department activity and prevent readmissions.
- Fundraising for operations: It may be a new concept for you, but you should craft a compelling story to tell to your growing philanthropic base of millennial millionaires, who will be looking to support programs like pediatrics and cancer care and not new buildings.
Enjoy the summer!