In a year full of new challenges for the home health and home care industry, one outstanding uncertainty has finally been put to rest—Donald Trump has won the U.S. presidency.
While America’s next president is decided, the impact to the home health industry, and the larger health care system, is still largely unknown. However, there are some policies and promises that have left the health care space reeling, while others leave room for hope.
Repeal and Replace
Where home care fits into the mix is still up in the air, though the Republican party has given the space some attention this election season.
“The election provides home care with a combination of challenges and opportunities,” William Dombi, vice president for law at the National Association for Home Care & Hospice (NAHC), told HHCN. “It should be noted at the outset that the Republican national platform stated that home care is a national public policy priority.”
In fact, both the Democratic and Republican parties specifically mentioned home care within their party platforms. While the Republican platform noted it would aim to “make homecare a priority,” there are some specific changes legislators have taken a stance on that could adversely impact the home health care industry.
One of the biggest upsets to the home health industry is the potential repeal of the Affordable Care Act (ACA), which President-elect Trump has promised to repeal. Doing so has also been a long-standing agenda item for Republicans in Congress, which also maintained a majority in both the Senate and House of Representatives on Tuesday’s election. With these results, a repeal may be a very plausible reality.
“Though complex, full repeal may not be a far reach for the president-elect,” a PricewaterhouseCoopers (PwC) report on the election results reads. “And even if Trump falls short of full repeal, he still may have Congressional and regulatory paths to more targeted changes.”
Some of those changes could shift the health care system away from government reimbursement toward private business, a Republican ideal, according to PWC.
In addition, a repeal of the ACA could end some of the reforms that have shifted the health care system away from fee-for-service payment models toward value-based purchasing. Home health care has only just started to implement mandatory VBP models in the last year, and many of these reforms came from ACA initiatives. While Trump has not specified what reforms he supports in lieu of the ACA, VBP as a concept could remain.
“Trump likely will support the continued move to value-based care, which, in part, pushes hospitals and health systems and other part of the industry to operate more like retailers,” the PwC report speculated. “But the savings results from value-based reforms have been mixed, which means hospitals, physicians and health systems can expect more tinkering in their reimbursement programs.”
The Partnership for Quality Home Healthcare (PQHH) still sees a path forward for VBP and other related to Medicare changes.
“There is still Congressional interest in chronic care improvement (Senate) and PAC value-based purchasing (House) that the PQHH is interested in,” Colin Roskey, chief staff executive of PQHH, told HHCN. “We don’t see those priorities slowing down in a Trump presidency. Both are bipartisan approaches to Medicare system and quality improvements.”
PQHH is also looking at the potential upside of of an ACA repeal, as some of the funding effects have been negative for home health agencies (HHAs).
“PQHH broadly supports the ACA’s coverage expansion goals, but remains troubled that they were in part achieved by removing Medicare funding resources from HHAs through rebasing, now in its last year,” Roskey said. “PQHH is ready to work with legislators on replacement policies to the ACA and other improvements that ensure access to high quality, skilled home health services in Medicare.”
Other changes to Medicare that are outlined by the Republican agenda are less welcomed by home health care groups.
“In terms of challenges, the House Republican leadership has supported certain Medicare changes that we do not support,” Dombi said. “For example, the Ryan plan for Medicare reform includes combining Medicare Part A and Part B into a single beneficiary cost-sharing model that would lead to copayments in hospice and home health.”
A home health care copayment has recently become a top agenda item for home care advocates. Some argue that copayments could deter Medicare beneficiaries from utilizing the home health care benefit.
Upon realization that Donald Trump would likely become America’s 45th president, economic indexes around the country and the world saw a steep drop. However, markets seemed to balance out by Wednesday, and the long-term impact of the election results may not shake the U.S. economy too hard.
In fact, health care stocks could be winners with this outcome “once the dust settles,” according to Deutsche Bank.
“We think the stock market sell-off will be short lived,” wrote David Bianco, strategist with Deutsche Bank. “We think this apparent Republican sweep is positive for the broad market and especially health care stocks.”
Specifically, other health care sectors, including pharmaceutical, biotech and medical devices, could see a 20%-plus rally once “the market digests this political shock,” Bianco said. Though, managed care companies could see a period of confusion and greater risk.
As predicted, hospital operators saw their stock values sink during trading Wednesday, according to The Washington Post. At the same time, drugmakers’ profits rose, buoyed by a lack potential price controls promised under a Clinton presidency, the Post reported.
Share prices of three of the largest publicly traded home health care companies—Almost Family (Nasdaq: AFAM), Amedisys Inc. (Nasdaq: AMED) and LHC Group Inc. (Nasdaq: LHCG)—were down Wednesday before mostly rebounding.
Looking forward, home care groups are pinning their hopes on the issues where Republicans align with the industry’s goals, particularly related to the most recently-implemented challenges such as the Pre-Claim Review Demonstration (PCRD).
“Home care has had significant support from Republicans on a number of difficult issues such as pre-claim review, face-to-face encounter certification and non-physician practitioners’ role in the Medicare home health benefit,” Dombi said. “In addition, Republicans did not support the Administration’s rule changes [for] companionship and live-in exemptions. We hope that the incoming Administration and Congress will help advance our agenda and goals on these and other issues.”
Written by Amy Baxter