OR Manager - February 2019 - 4

Editorial
www.ormanager.com
EDITOR
Elizabeth Wood * 301-354-1786 * ewood@accessintel.com
CLINICAL EDITOR
Judith M. Mathias, MA, RN
CONTRIBUTING WRITERS
Janet M. Boivin, BSN, BSJ, RN,
Cynthia Saver, MS, RN
Catherine Spader, RN
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Pepper Coe
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Vol. 35, No. 2 February 2019 * OR Manager (ISSN 87568047)
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E
arly in a new year, there's a tendency
to reflect on how past
events might inform the future.
The January issue of OR Manager looked
at 2018 legislative changes and their
potential impact on healthcare. In just
the past few weeks, several legal and financial
actions have already changed the
picture. Here is a snapshot of the latest
developments and experts' ideas about
what these mean to the industry.
Wobbly foundations
Factors such as the temporary partial
government shutdown, volatile financial
markets, and ongoing legal battles
over the fate of the Affordable Care
Act (ACA) do not inspire confidence.
A Texas judge in mid-December 2018
ruled the ACA unconstitutional, and in
January, several Democratic state attorneys
general filed a notice of appeal.
It's widely believed that the issue will
move through the courts and perhaps
ultimately will escalate to the Supreme
Court.
Supporters of the ACA worry about
loss of coverage for preexisting conditions
and spikes in insurance premiums,
whereas President Trump and
other lawmakers believe there are alternatives
that will ensure adequate
and affordable coverage. Then there
is the question of what might happen
to the Medicare payment models
and Medicaid expansion implemented
under the ACA.
Impact on payment models
Would repeal of the ACA undo the work
that has gone into adopting valueThreat
of ACA
repeal looms
once again.
based care? Many healthcare experts
think not, and the Centers for Medicare
& Medicaid Services (CMS) has
expressed its ongoing commitment
to value-based payment. In fact, the
agency recently did an about-face after
converting some previous mandatory
payment models for certain cardiac procedures
to voluntary.
At a speech during the Patient-Centered
Primary Care Collaborative Conference
in late 2018, Health and Human
Services Secretary Alex Azar said: " We
intend to revisit some of the episodic
cardiac models that we pulled back,
and are actively exploring new and improved
episode-based models in other
areas, including radiation oncology. "
Reports about the effectiveness of
bundled payments have been mixed
over the years, and the shifting positions
on voluntary vs mandatory have
made adoption far from straightforward.
Still, several experts we spoke with
last year anticipated much growth in
bundled payment programs for orthopedic
procedures (OR Manager, September
2018; 1, 13-17, 19 and October
2018; 15-17, 21), and offered advice
for healthcare leaders looking to implement
such programs.
A recent assessment of Medicare's
Comprehensive Care for Joint Replacement
model found a modest reduction
Continued on page 5
nurses. Learn
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OR Manager - February 2019

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