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Physician sees good things in a Trump health program

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Anish Koka, M.D., a pro-Trump cardiologist in Philadelphia, thinks that the next president may well be good for physicians and patients. Among his observations in a Medical Economics essay:

“Millions of patients currently with insurance would suddenly lose their health plans {if the Affordable Care Act-created insurance marketplaces were abolished, as Mr. Trump has called for}. No one wants this, and Trump and the Republican Party now face intense pressure to come up with a replacement. As a result, I find it very unlikely that physicians or patients will suddenly have to deal with a large number of patients without insurance. There are also encouraging signs that the replacement plans being discussed will more than likely include health savings accounts—a Trump/GOP favorite—that will be allowed to directly pay primary care physicians in a subscription model similar to direct primary care. This capitated model puts physicians, rather than insurance companies, in the driver’s seat and would be music to the ears of primary care physicians in desperate need of a lifeline.”

“The biggest immediate headache is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which physicians will have to face in less than two months, but it only slightly overlaps with the ACA. The overlap relates to the Center for Medicare & Medicaid Innovation (CMMI) that was funded by the ACA, and created some of the important value-based payment models physicians were going to have to comply with to avoid reimbursement penalties. The wide latitude given CMMI to propose and deploy Advanced Alternative Payment Models (APMs) under Medicare payment reform has already come under scrutiny by Republican legislators prior to a Trump victory. One would expect that in the Trump era, CMMI is unlikely to survive in its current form. This would provide significant relief to physician practices enrolled in APMs struggling to cope with the time and cost of the seeming barrage of regulatory hoops to jump through.”

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