Q&A with MGMA’s Anders Gilberg: Lasting healthcare reform ‘needs to start in the middle’

To call the last few months a busy time for healthcare lobbyists in Washington, D.C. would be quite an understatement. Rather than dwell on the failed attempts at repealing the Affordable Care Act, the Medical Group Management Association’s (MGMA) senior vice president of government affairs, Anders Gilberg, will look ahead to more immediate regulatory concerns and longer-term hopes for “lasting reform.”

Ahead of his general session presentation, Gilberg spoke to HealthExec comparing the legislative and executive branches’ approaches to healthcare policy in the Donald Trump era and whether the ACA repeal process could spell trouble for providers if single-payer legislation gains more momentum.

HealthExec: How can you sum up the last few months in the D.C. healthcare policy world to MGMA members?

Anders Gilberg: Like a lot of folks, our members have some degree of fatigue over the political aspects of what happened over the last two months. My job won’t be to relive the political drama of repeal-and-replace, but to break it down for people who are really delivering care and make it meaningful and explain what the ramifications are with some of the instability, like the cost-sharing reduction subsidies which are kind of fundamental to the operation of the exchanges. My job is not to get into the political element, but the practical realities.

With ACA repeal seemingly on the backburner, what are some of the more immediate regulatory concerns for MGMA members?

There are a couple of very important regulations which will be finalized around Nov. 1, including the 2018 rule for the Quality Payment Program—the (Merit-based Incentive Payment System) and (Advanced Alternative Payment Models). In addition, there’s also the fee schedule for 2018, which is 1,000 pages. It doesn’t just set fees, there’s a number of policies in there that are meaningful to medical groups.

Outside of those regulations, one of the main efforts this administration has embarked on has been regulatory relief. I had an opportunity to participate in a forum at HHS called “Cut the Red Tape: Liberating American From Bureaucracy.” One thing that’s very clear about this administration is their emphasis on deregulation. For medical groups and physicians, that can be a very good thing, given the sheer volume of rules and regulations that they have to deal with on a day-to-day basis. I’m going to talk about what that means for them and some opportunities to reduce the regulatory burden for medical groups in the next year.

Is there a noticeable difference in how things are moving on the regulatory side under the new administration compared to the more well-documented legislative battles on healthcare?

For all of the drama on the legislative front, where have we gotten? Nowhere. Has anything changed? Not really. If anything, it’s become more partisan. The regulations, they don’t necessarily stop because of the legislative process, they continue to go forward. You have to be very vigilant in making sure your practice is prepared because a lot of the new payment regulations can have a material impact on your business. If physicians get low quality scores, that will reduce the reimbursement they receive.

There’s also a proposal to delay the upgrade requirements for certified electronic health records (EHRs). We hope to see that finalized. If it’s not finalized, then medical groups would have to upgrade their EHRs in 2018. That’s a huge issue for medical groups and it would be a huge expenditure to work with an existing vendor or possibly invest in new technology.

There’s a lot of things that are taking place that, if you’re leading a medical group, you need to be aware of. You can’t just get all caught up in the drama of the legislative process because that is not where a lot of the action is. A lot of the more tangible things affecting MGMA members will be in regulatory arena.

What about longer-term concerns over how the ACA repeal process played out—one party nearly passed legislation which almost every industry group lobbied against. How does that affect the voice of an organization like yours in future policy debates?

I think that’s a problem when Congress ignores the input of all stakeholders, except political stakeholders. Everybody expressed, to varying degree, some concern, but a lot of that was because we barely got the chance to participate in the process. Most of the legislation just hasn’t been vetted in the light of day. I think it’s been clear that the effort has been a political one. The promise was made to repeal the ACA and the Republican House and Senate wants to make good on that promise. I think, unfortunately, the real world ramifications haven’t been discussed in any great detail, whereas the political ramifications are where the primary impetus has been for repeal.

That has the potential to be a problem for the healthcare system, because uncertainty is bad for the system. If we keep taking these big whipsaw changes every several years, having this pendulum swing back and forth, it’s just not good for our healthcare system. Lasting reform starts from the middle. If you have a situation in which legislation or reform is driven by the extremes on both sides, it swings back and forth. With lasting reform, it needs to start in the middle and then go out and get as much consensus and then go out to the extremes and gather as much support to keep what’s going to be decided stable and in place.

We’re happy to look at some of the shortcomings of the ACA. It’s not necessarily been extremely effective in all areas, but we don’t want this constant disruption to our healthcare system.

On the other side from repeal, there’s been more support from Democrats for Medicare-for-all, single-payer healthcare. How seriously do MGMA members take those proposals?

There seems to be growing support for Medicare-for-all, but until you add in what that would add in what they would mean in terms of tax increases or you look at examples where states have tried to implement it, it’s difficult. I see that in the same way as I see just outright repeal of the ACA. You have complete free-market, libertarian approach that (Sen. Rand) Paul would take and then you’ve got (Sen.) Bernie Sanders with a socialized system. You’re not going to have success in either one of those extremes.

The short answer is I do not expect there to be a single-payer healthcare system in the United States. There’s just not support for it. The reality is the tax increases that would need to be necessary to support it just will not pass. But it does reflect the polarization of the issue. If we’re going to continue to have polarization, we’re not going to create any stability in our system.

I don’t give (single-payer) high marks in terms of its prospects, but it’s definitely thought-provoking given all the debate on the other side of the equation this year.