The physician industry faces a great deal of uncertainty under President-elect Donald Trump’s administration.

Changing or repealing the Affordable Care Act (ACA) is a promise President-elect Trump has committed to accomplish. His proposed cabinet includes those who have promoted ACA repeal, as well as massive changes in Medicare and Medicaid. Many Republican lawmakers have been waiting for this very opportunity and are looking at how it can be replaced.

Any and all changes made will inevitably impact how physicians care for patients.

Here are physician-related issues to watch as the healthcare industry braces for change:

  • The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, authorized the Centers for Medicare & Medicaid Services to create numerous value-based payment models with which physicians would have to comply to avoid reimbursement penalties. The implementation of MACRA could be impacted if the new administration makes changes to the CMS Innovation Center. Any change in MACRA would not impact physicians immediately, but could affect reimbursements in the long term.
  • The CMS Innovation Center has come under fire by Republican lawmakers and may not survive under a Trump administration. This would alleviate pressure on practices that are participating in advanced payment plans and struggling to implement new regulations and requirements tied to reimbursement. A dissolution of the innovation center would also potentially hinder positive patient outcomes and cost reductions associated with these initiatives.
  • Some of the ACA replacement discussion will likely include health savings accounts that would directly pay physicians in a subscription model that is similar to direct primary care. This type of capitated model puts physicians, rather than insurance companies, in the driver’s seat, according to a blog written by cardiologist Anish Koka in Modern Economics. Koka said primary-care physicians would benefit from this model.
  • Eighteen states have adopted legislation, including six in 2016, allowing the interstate licensing of physicians under The Interstate Medical Licensure Compact. The compact makes it easier for physicians to be licensed to practice medicine in multiple states. It increases access to healthcare in underserved areas and allows providers to connect through telemedicine technologies. Expect more states to adopt this legislation if the forthcoming healthcare changes allow consumers to purchase insurance across state lines. It’s a concept that was nearly included in the existing ACA. Either way, physician networks and consolidation will begin to change dramatically as more states adopt this legislation.
  • Since the ACA’s implementation, physicians have invested time, resources, and massive amounts of money to implement medical home initiatives and install electronic medical record systems to shift to value-based or alternative payment models and comply with increasing regulatory requirements. It is unclear if any of these initiatives will be impacted, but those investments have been made so it’s unlikely these initiatives will be discontinued.
  • Under President-elect Trump’s tax plans, the corporate tax rate may be lowered from 35 percent to 15 percent for businesses that receive a 1099 form and operate under a corporation, according to Physician’s Money Digest. Many physicians, including emergency medical physicians and anesthesiologists, receive income through a corporate entity. If the corporate tax structure is changed, the tax break could have a significant positive impact on a practice’s bottom line.

It’s too early to tell what will actually change, but the physician industry will no doubt be keeping a close eye on these issues and the numerous other ways they will be impacted, positively or negatively.

Valerie Pillo is an analyst at DRG and specializes in physicians industry topics. Follow her on Twitter at @ValeriePilloDRG.


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