The most important federal health care legislation passed into law was the passage of the 21st Century Cures Act of 2016, which stimulates drug development and discovery of new cures and treatments. It also contained several key provisions important to Texas Health, including:
- Revising the 2015 Bipartisan Budget Act, which prevented off-campus hospital outpatient departments (HOPDs) from receiving full Medicare reimbursement after a certain date for such services as nursing, laboratory, imaging or chemotherapy. The 2015 legislation also cut funding to HOPDs that were in mid-build, relocating or expanding, which would have impacted Texas Health Neighborhood Care & Wellness Prosper’s and Texas Health Harris Methodist Hospital Azle’s ability to deliver much-needed care. The 2016 law restored some of the Medicare reimbursement for these two entities.
- Adjusting the Hospital Readmissions Reduction Program to account for socioeconomic status. Previously, hospitals were penalized financially if patients were readmitted within 30 days regardless if that readmission had anything to do with the original condition. There also are factors beyond a hospital’s control that can impact readmission rates, such as poorer patients, who often have inadequate access to care and lack resources to improve their health. With the passage of the law, these types of socioeconomic factors will be considered.
- Reversing a 2009 ruling that called for hospitals and physicians to directly supervise outpatient therapeutic services that are provided in critical access hospitals and certain small, rural hospitals. This administrative burden took physician time away from patient care and threatened the ability for rural hospitals to attract the number of physicians they needed.
In Texas, the five-year Medicaid 1115 Transformation Waiver was set to expire in September 2016. Designed to decrease health care costs while improving access, quality and care coordination, the waiver funds more than 1,400 Delivery System Reform Incentive Payment projects statewide—including 39 projects managed by 12 Texas Health hospitals.
These projects include clinics, emergency department navigation, chronic disease education and management, behavioral health screening and referral, mobile cancer screening, palliative care and medication management, among others. Combined, these projects have served more than 40,000 people who are primarily Medicaid beneficiaries and low-income uninsured. The projects also helped Texas Health earn more than $116 million for achieving outcomes and reporting requirements, and saved the health system more than $5 million.
Fortunately, the Centers for Medicare and Medicaid Services approved a 15-month extension of the waiver, allowing funding to continue through December 31, 2017. Texas Health’s financial sustainability is dependent in part on this waiver, and we will continue to advocate for its long-term extension.
No matter what happens in Austin or Washington, D.C., Texas Health will continue to chart its own course by inspiring change in the way consumers think about their own health and well-being. The most effective health care reform will happen at the local level, where care is delivered through collaboration among health systems, physicians, employers, insurance companies and patients.
As health care reform evolves, our advocacy efforts will continue to draw on the collective strength of Texas Health’s senior leadership, employees, clinicians, trustees and volunteers. These strategies will enable our system to lead, and they will be our focus as we move forward in shaping policy to advance health and well-being.